Use of potentially inappropriate pain-related medications in older adults with painful neuropathic disorders.
BACKGROUND
Although older adults with painful neuropathic disorders (PNDs) would appear to be at elevated risk for receiving potentially inappropriate pain-related medications, the extent of such drug use in this population is unknown.


OBJECTIVE
The goal of this study was to assess the use of potentially inappropriate pain-related medications among patients with PNDs aged >or=65 years.


METHODS
Using a large, integrated US health insurance database, we identified all persons aged >or=65 years with >or=2 medical encounters involving diagnoses of PNDs during calendar year 2000. Patients with <30 days of continuous eligibility for health benefits during the study year were excluded from the sample. Use of potentially inappropriate pain-related medications (as defined by the 1997 Beers criteria) was then examined based on information contained in paid pharmacy claims for all remaining patients.


RESULTS
We identified 22,668 patients with PNDs aged >or=65 years (mean [SD] age, 73.9 [6.0] years; 58.6% female). Almost one half (11,233 [49.6%]) of patients received >or=1 potentially inappropriate pain-related medication, including propoxyphene (26.7%) and amitriptyline (10.2%). Women were more likely than men to receive these medications (54.2% vs 43.0%, respectively; P<0.01), and use increased with age (47.6%, 51.8%, and 52.8% in those aged 65-74 years, 75-84 years, and >or=85 years, respectively; overall comparison, P<0.01). Among patients with only 1 PND, the use of potentially inappropriate medications was highest among those with postherpetic neuralgia (70.1%).


CONCLUSIONS
Use of potentially inappropriate pain-related medications among older adults with PNDs is common. Further research is needed to ascertain whether the benefits of these agents outweigh their risks in this population.
Oster
Gerry
G
Policy Analysis, Inc., Brookline, Massachusetts 02445, USA. goster@pai2.com
Berger
Ariel
A
Dukes
Ellen
E
Edelsberg
John
J
McCarberg
Bill
B
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D016208:Databases, Factual; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D010146:Pain / Q000188:drug therapy*; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy*; D016896:Treatment Outcome
D000700:Analgesics