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Patterns of pain medication use associated with reported pain interference in older adults with and without cancer

  • Amy J. DavidoffEmail author
  • Maureen E. Canavan
  • Shelli Feder
  • Shiyi Wang
  • Ella Sheinfeld
  • Erin E. Kent
  • Jennifer Kapo
  • Carolyn J. Presley
Original Article

Abstract

Context

Concerns about the adequacy of pain management among older adults are increasing, particularly with restrictions on opioid prescribing.

Objectives

To examine associations between prescription pain medication receipt and patient-reported pain interference in older adults with and without cancer.

Methods

Using the 2007–2012 Surveillance Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D prescription claims, we selected MHOS respondents (N = 15,624) aged ≥ 66 years, ≤ 5 years of a cancer diagnosis (N = 9105), or without cancer (N = 6519). We measured receipt of opioids, non-steroidal anti-inflammatory drugs, and antiepileptics, and selected antidepressants within 30 days prior to survey. Patient-reported activity limitation due to pain (pain interference) within the past 30 days was summarized as severe, moderate, or mild/none. Logistic regression using predictive margins estimated associations between pain interference, cancer history, and pain medication receipt, adjusting for socio-demographics, chronic conditions, and Part D low-income subsidy.

Results

Severe or moderate pain interference was reported by 21.3% and 46.1%, respectively. Pain medication was received by 21.5%, with 11.6% receiving opioids. Among adults reporting severe pain interference, opioid prescriptions were filled by 27.0% versus 23.8% (p = 0.040) with and without cancer, respectively. Over half (56%) of adults reporting severe pain in both groups failed to receive any prescription pain medication.

Conclusions

Older adults with cancer were more likely to receive prescription pain medications compared with adults without cancer; however, many older adults reporting severe pain interference did not receive medications. Improved assessment and management of pain among older adults with and without cancer is urgently needed.

Keywords

Pain treatment Opioids Pain interference Cancer Medicare part D Medicare health outcomes study 

Notes

Acknowledgments

This study used data from the SEER-MHOS linked data resource. The authors acknowledge the efforts of the National Cancer Institute; the Centers for Medicare & Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-MHOS database.

Funding information

This research was funded through a contract with the National Cancer Institute (Contract HHSN261201700690P).

Compliance with ethical standards

Conflict of interest

EEK was a contractor for NCI and assisted with project oversight as well as contributing substantial intellectual input. AJD’s institution receives research funding from Celgene Corporation outside of the submitted project. CJP is a Paul Calabresi Scholar supported by the OSU K12 Training Grant for Clinical Faculty Investigators (K12 CA133250) and is a consultant for Potentia Metrics. SW’s institution receives funding from Genentech to support his research. No other author reports any conflict of interest to disclose. The research team had direct control of the data throughout the study project. We are unable to release the data to other researcher due to constraints of the Data Use Agreement with the NCI. However, we would be willing to provide SAS code for selection of medications identified in the analysis.

Disclaimer

The interpretation and reporting of these data are the sole responsibility of the authors and do not reflect the positions of the National Cancer Institute, the Centers for Medicare & Medicaid Services, or the U.S. Department of Health and Human Services.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Yale School of Public HealthNew HavenUSA
  2. 2.Yale Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) CenterYale School of MedicineNew HavenUSA
  3. 3.Yale Cancer CenterNew HavenUSA
  4. 4.Yale National Clinical Scholars ProgramYale School of MedicineNew HavenUSA
  5. 5.Yale Fox FellowshipNew HavenUSA
  6. 6.Tel Aviv UniversityTel AvivIsrael
  7. 7.National Cancer Institute, Bethesda, MDFairfaxUSA
  8. 8.ICF, IncFairfaxUSA
  9. 9.Yale School of MedicineNew HavenUSA
  10. 10.The Ohio State University Comprehensive Cancer CenterColumbusUSA

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