title: Pain Treatment of Underserved Older African Americans.
abstract: Older African Americans who experience pain are especially at high risk of underassessment and undertreatment. This study examined patterns and correlates of pain medication use: severity of pain, medical conditions, and access to care. African Americans aged 65 and older were recruited from 16 churches located in south Los Angeles (N = 400). Structured face-to-face interviews and visual inspection of each participant's medications were conducted. More than 39% of participants were aged 75 and older, and 65% were female. Forty-seven percent used at least one type of pain medication. The frequency of pain medication use according to pharmaceutical class was nonopioid, 33%; opioid, 12%; adjuvant, 9%; and other drug, 8%. Seventy-seven percent of nonopioids were nonsteroidal anti-inflammatory drugs (NSAIDs), which 25% of participants with hypertension, 28% with stroke, 26% with kidney disease, and 28% with gastrointestinal problems used. Ninety-eight percent of participants who used NSAIDs, 98% experienced potentially inappropriate medication (PIM) use, 69% experienced drug duplication, and 65% experienced drug-drug interactions. This study suggests severe mismanagement of pain in underserved older African Americans, particularly those with comorbidity, multiple providers, and limited access to health care. The use of pain medication was associated with drug-drug interactions, drug duplication, and PIM use. The data show that many participants with severe pain are not taking pain medication or experience PIM use. One in four participants was taking NSAIDs, which can cause serious side effects in older African Americans with multiple chronic conditions.
authors: Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.|Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors: Hamed
authors: H
authors: Yazdanshenas
authors: Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California. mobazarg@cdrewu.edu.|Department of Family Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California. mobazarg@cdrewu.edu.
authors: Mohsen
authors: M
authors: Bazargan
authors: Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.
authors: James
authors: J
authors: Smith
authors: Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California.|Department of Internal Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
authors: David
authors: D
authors: Martins
authors: Department of Internal Medicine, Lincoln Medical and Mental Health Center, New York, New York.
authors: Hooman
authors: H
authors: Motahari
authors: School of Pharmacy, Keck Graduate Institutes, Claremont, California.
authors: Gail
authors: G
authors: Orum
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006297:Health Services Accessibility; D006300:Health Services Misuse / Q000517:prevention & control; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D012720:Severity of Illness Index
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: African American; medication; older adults; pain