Pharmacotherapy of Pain in Depressed Older Adults

Authors

  • Jürgen Unützer MD, MPH,

    1. From the *Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WashingtonCenter for Health Services Research, Neuropsychiatric Institute, and Division of Geriatric Medicine, School of Medicine, University of California at Los Angeles, Los Angeles, California§Group Health Cooperative, Seattle, Washington.
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  • Bruce Ferrell MD,

    1. From the *Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WashingtonCenter for Health Services Research, Neuropsychiatric Institute, and Division of Geriatric Medicine, School of Medicine, University of California at Los Angeles, Los Angeles, California§Group Health Cooperative, Seattle, Washington.
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  • Elizabeth H. B. Lin MD, MPH,

    1. From the *Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WashingtonCenter for Health Services Research, Neuropsychiatric Institute, and Division of Geriatric Medicine, School of Medicine, University of California at Los Angeles, Los Angeles, California§Group Health Cooperative, Seattle, Washington.
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  • Tonya Marmon MS

    1. From the *Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WashingtonCenter for Health Services Research, Neuropsychiatric Institute, and Division of Geriatric Medicine, School of Medicine, University of California at Los Angeles, Los Angeles, California§Group Health Cooperative, Seattle, Washington.
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  • This study was supported by grants from the John A. Hartford Foundation, the California Healthcare Foundation, and the American Federation for Aging Research.

Jürgen Unützer, MD, MPH, University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195.
E-mail: unutzer@u.washington.edu

Abstract

Objectives: To examine pharmacotherapy for pain in a sample of 1,801 depressed older primary care patients.

Design: Cross-sectional survey data collected from 1999 to 2001.

Setting: Eighteen primary care clinics belonging to eight healthcare organizations in five states.

Participants: One thousand eight hundred one patients aged 60 and older who met diagnostic criteria for major depression or dysthymia.

Measurements: Diagnoses or treatment for chronic pain, functional impairment from pain, and use of over-the-counter and prescription analgesic medications.

Results: One thousand four hundred sixteen (79%) participants reported functional impairment from pain in the previous month, and 1,024 (57%) reported a diagnosis of or treatment for chronic pain in the previous 3 years. Fifty-one percent of those with recent functional impairment from pain reported any analgesic use, ranging from 31% to 75% across the participating healthcare organizations. Opioid analgesic use varied from 5% to 34%. Predictors of analgesic use included a history of chronic pain or arthritis and the degree of functional impairment from pain in the previous month. Differences in analgesic use across participating organizations remained significant after adjusting for clinical and demographic covariates.

Conclusion: Most depressed older adults in the sample reported recent functional impairment from pain and a history of chronic pain, but almost half of those with functional impairment from pain did not report using analgesic medications. Participating organizations varied substantially in their use of analgesics, suggesting that there is room to improve the quality of pain management in depressed older adults.

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