Management of Nonmalignant Pain in Home-Dwelling Older People: A Population-Based Survey


Address correspondence to Dr. Kaisu H. Pitkala, Helsinki University Hospital, Department of Medicine, Geriatric Clinic, P.O. Box 340, FIN-00029 HUS, Finland. E-mail:


OBJECTIVES: To investigate use of prescribed analgesic drugs in relation to experience of joint or back pain in a home-dwelling older population, to study changes in the use of analgesic drugs over 10 years, and to investigate concomitant use of protective gastrointestinal drugs with prescribed analgesic drugs in 1999.

DESIGN: Cross-sectional mailed surveys 10 years apart.

SETTING: Helsinki, Finland.

PARTICIPANTS: Random samples of older birth cohorts born in 1904, 1909, and 1914 in 1989 (n = 644) , and of three separate cohorts born in 1914, 1919, and 1924 in 1999 (n = 3,000).

MEASUREMENTS: Use of various types of analgesic and protective gastrointestinal drugs, prescribed and over the counter. Experience of joint and back pain that interferes with daily functioning.

RESULTS: The response rate of home-dwelling older people was 83% in 1989 and 81% in 1999. Although the use of analgesic drugs as self-treatment increased from 28.5% to 41.4% during the 10 years, in 1999, only 35.5% to 38.2% of those suffering joint or back pain that impaired daily functioning had been prescribed an analgesic drug for regular use. Of those using prescribed medication, 57.5% were on nonsteroidal antiinflammatory drugs (NSAIDs), 20.9% acetaminophen, and 18.5% weak opiates. Only one-fifth of those individuals taking NSAIDs were on a concomitant gastroprotective drug.

CONCLUSIONS: Pain is markedly undertreated in community-dwelling older people, which may have serious implications for their well-being and functioning. Although we noted a tendency for safety in the use of prescribed analgesic drugs, a significant effort must sill be made to implement evidence-based practice. Self-treatment of pain has increased in 1 decade, which may reduce the overall safety of analgesic drug use among older people.