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  • Title: Use of potentially inappropriate pain-related medications in older adults with painful neuropathic disorders.
    Author: Oster G, Berger A, Dukes E, Edelsberg J, McCarberg B.
    Journal: Am J Geriatr Pharmacother; 2004 Sep; 2(3):163-70. PubMed ID: 15561648.
    Abstract:
    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.
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