Analgesic Use for Knee and Hip Osteoarthritis in Community-Dwelling Elders

Authors

  • Zachary A. Marcum PharmD,

    Corresponding author
    1. Departments of Medicine (Geriatrics)
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  • Subashan Perera PhD,

    1. Departments of Medicine (Geriatrics)
    2. Departments of Biostatistics
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  • Julie M. Donohue PhD,

    1. Health Policy and Management,
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  • Robert M. Boudreau PhD,

    1. Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Anne B. Newman MD, MPH,

    1. Departments of Medicine (Geriatrics)
    2. Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Christine M. Ruby PharmD,

    1. Departments of Medicine (Geriatrics)
    2. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Stephanie A. Studenski MD, MPH,

    1. Departments of Medicine (Geriatrics)
    2. Center for Health Equity Research and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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  • C. Kent Kwoh MD,

    1. Medicine (Rheumatology and Clinical Immunology), School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
    2. Center for Health Equity Research and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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  • Eleanor M. Simonsick PhD,

    1. Intramural Research Program, National Institute on Aging, Baltimore, Maryland
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  • Doug C. Bauer MD,

    1. Department of Medicine (General Internal Medicine), School of Medicine, University of California, San Francisco, California
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  • Suzanne Satterfield MD, DrPH,

    1. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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  • Joseph T. Hanlon PharmD, MS,

    1. Departments of Medicine (Geriatrics)
    2. Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
    3. Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
    4. Center for Health Equity Research and Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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  • for the Health, Aging and Body Composition Study


  • Disclosure: None of the authors has any relevant conflict of interest/financial disclosures.

  • Presented as a poster at the Gerontological Society of America Annual Scientific Meeting in New Orleans, LA, in November 2010.

Zachary A. Marcum, PharmD, University of Pittsburgh; Department of Medicine (Geriatrics), School of Medicine, Kaufmann Medical Building, Suite 500, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Tel: 412-864-2894; Fax: 412-692-2370; E-mail: zam12@pitt.edu.

Abstract

Objective.  To examine the prevalence and correlates of non-opioid and opioid analgesic use and descriptively evaluate potential undertreatment in a sample of community-dwelling elders with symptomatic knee and/or hip osteoarthritis (OA).

Design.  Cross-sectional.

Setting.  Health, Aging, and Body Composition Study.

Patients.  Six hundred and fifty-two participants attending the year 6 visit (2002–03) with symptomatic knee and/or hip OA.

Outcome Measures.  Analgesic use was defined as taking ≥1 non-opioid and/or ≥1 opioid receptor agonist. Non-opioid and opioid doses were standardized across all agents by dividing the daily dose used by the minimum effective analgesic daily dose. Inadequate pain control was defined as severe/extreme OA pain in the past 30 days from a modified Western Ontario and McMaster Universities Osteoarthritis Index.

Results.  Just over half (51.4%) reported taking at least one non-opioid analgesic and approximately 10% was taking an opioid, most (88.5%) of whom also took a non-opioid. One in five participants (19.3%) had inadequate pain control, 39% of whom were using <1 standardized daily dose of either a non-opioid or opioid analgesic. In adjusted analyses, severe/extreme OA pain was significantly associated with both non-opioid (adjusted odds ratio [AOR] = 2.44; 95% confidence interval [95% CI] = 1.49–3.99) and opioid (AOR = 2.64; 95% CI = 1.26–5.53) use.

Conclusions.  Although older adults with severe/extreme knee and/or hip OA pain are more likely to take analgesics than those with less severe pain, a sizable proportion takes less than therapeutic doses and thus may be undertreated. Further research is needed to examine barriers to optimal analgesic use.

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