title: Predictors of Improvements in Pain Intensity in a National Cohort of Older Veterans With Chronic Pain.
abstract: Little is known about the factors associated with pain-related outcomes in older adults. In this observational study, we sought to identify patient factors associated with improvements in pain intensity in a national cohort of older veterans with chronic pain. We included 12,924 veterans receiving treatment from the Veterans Health Administration with persistently elevated numeric rating scale scores in 2010 who had not been prescribed opioids in the previous 12 months. We examined: 1) percentage decrease over 12 months in average pain intensity scores relative to average baseline pain intensity score; and 2) time to sustained improvement in average pain intensity scores, defined as a 30% reduction in 3-month scores compared with baseline. Average relative improvement in pain intensity scores from baseline ranged from 25% to 29%; almost two-thirds met criteria for sustained improvement during the 12-month follow-up period. In models, higher baseline pain intensity and older age were associated with greater likelihood of improvement in pain intensity, whereas Veterans Affairs service-connected disability, mental health, and certain pain-related diagnoses were associated with lower likelihood of improvement. Opioid prescription initiation during follow-up was associated with lower likelihood of sustained improvement. The findings call for further characterization of heterogeneity in pain outcomes in older adults as well as further analysis of the relationship between prescription opioids and treatment outcomes.
  
  
  
  This study identified factors associated with improvements in pain intensity in a national cohort of older veterans with chronic pain. We found that older veterans frequently show improvements in pain intensity over time, and that opioid prescriptions, mental health, and certain pain diagnoses are associated with lower likelihood of improvement.
authors.affiliation: Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health and Science University, Portland, Oregon. Electronic address: steven.dobscha@va.gov.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
authors.affiliation: Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health and Science University, Portland, Oregon.
authors.forename: Travis I
authors.initials: TI
authors.lastname: Lovejoy
authors.affiliation: Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health and Science University, Portland, Oregon.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Morasco
authors.affiliation: Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kovas
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Peters
authors.affiliation: Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon.
authors.forename: Kyle
authors.initials: K
authors.lastname: Hart
authors.affiliation: Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon.
authors.forename: J Lucas
authors.initials: JL
authors.lastname: Williams
authors.affiliation: Department of Psychiatry, Oregon Health and Science University, Portland, Oregon; Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Bentson H
authors.initials: BH
authors.lastname: McFarland
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011237:Predictive Value of Tests; D055553:Prescription Drugs / Q000627:therapeutic use; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D055553:Prescription Drugs
keywords: Chronic pain; Numeric Rating Scale; aged; analgesics; opioid; veterans