title: Pain severity and pharmacologic pain management among community-living older adults: the MOBILIZE Boston study.
abstract: BACKGROUND
  Concerns about polypharmacy and medication side effects contribute to undertreatment of geriatric pain. This study examines use and effects of pharmacologic treatment for persistent pain in older adults.
  
  
  METHODS
  The MOBILIZE Boston Study included 765 adults aged ≥70 years, living in the Boston area, recruited from 2005 to 2008. We studied 599 participants who reported chronic pain at baseline. Pain severity, measured using the Brief Pain Inventory (BPI) severity subscale, was grouped as very mild (BPI <2), mild (BPI 2-3.99), and moderate to severe (BPI 4-10). Medications taken in the previous 2 weeks were recorded from medication bottles in the home interview.
  
  
  RESULTS
  Half of participants reported using analgesic medications in the previous 2 weeks. Older adults with moderate to severe pain were more likely to use one or more analgesic medications daily than those with very mild pain (49 versus 11%, respectively). The most commonly used analgesic was acetaminophen (28%). Opioid analgesics were used daily by 5% of participants. Adjusted for health and demographic factors, pain severity was strongly associated with daily analgesic use (moderate-severe pain compared to very mild pain, adj. OR 7.19, 95% CI 4.02-12.9). Nearly one third of participants (30%) with moderate to severe pain felt they needed a stronger pain medication while 16% of this group were concerned they were using too much pain medication.
  
  
  CONCLUSIONS
  Serious gaps persist in pain management particularly for older adults with the most severe chronic pain. Greater efforts are needed to understand barriers to effective pain management and self-management in the older population.
authors.affiliation: College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA. ampicha.nawai001@umb.edu.
authors.forename: Ampicha
authors.initials: A
authors.lastname: Nawai
authors.affiliation: College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA.|Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Suzanne G
authors.initials: SG
authors.lastname: Leveille
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Shmerling
authors.affiliation: College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA.
authors.forename: Guusje
authors.initials: G
authors.lastname: van der Leeuw
authors.affiliation: Harvard Medical School, Boston, MA, USA.|New England Geriatric, Research, Education and Clinical Center, Boston Veterans Administration Health System, Boston, MA, USA.|Spaulding Rehabilitation Hospital, Boston, MA, USA.
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Bean
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D059350:Chronic Pain / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management / Q000706:statistics & numerical data*; D010147:Pain Measurement; D019338:Polypharmacy
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000082:Acetaminophen
keywords: Analgesic medications; Epidemiology; Older adults; Pain; Side effects