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Management of Persistent Pain in Older Adults: The MOBILIZE Boston Study

Authors

  • Carrie Stewart BSc,

    Corresponding author
    • Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
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  • Suzanne G. Leveille PhD,

    1. College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts
    2. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    3. Department of Medicine, Harvard Medical School, Boston, Massachusetts
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  • Robert H. Shmerling MD,

    1. Department of Medicine, Harvard Medical School, Boston, Massachusetts
    2. Division of Rheumatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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  • Elizabeth J. Samelson PhD,

    1. Department of Medicine, Harvard Medical School, Boston, Massachusetts
    2. Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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  • Jonathan F. Bean MD,

    1. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
    2. Spaulding Rehabilitation Hospital, Boston, Massachusetts
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  • Pat Schofield PhD

    1. School of Health and Social Care, University of Greenwich, Greenwich, UK
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Address Correspondence to Carrie Stewart, Centre of Academic Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK. E-mail: Carrie.stewart.06@aberdeen.ac.uk

Abstract

Objectives

To describe the prevalence of pharmacological (PS) and nonpharmacological (NPS) pain management approaches used by older adults with persistent pain and to identify characteristics associated with use of these approaches.

Design

Population-based cohort.

Setting

Urban and suburban communities in the Boston, Massachusetts, area.

Participants

Seven hundred sixty-five adults aged 64 and older underwent a home interview and clinic examination. Those reporting any persistent pain were included in this analysis (N = 599).

Measurements

All prescription and nonprescription medications were recorded during the home interview. NPS modalities for pain management were assessed using a modification of the Pain Management Inventory. The baseline assessment included extensive measures of pain, health, and functioning.

Results

More than one-third (37.5%) of participants reported using both PS and NPS modalities. Thirty-one percent reported use of NPS modalities alone, and 11.5% used PS modalities alone. NPS modalities (68.4%) were reported more frequently than PS modalities (49%). Women (odds ratio (OR) = 2.2, 95% confidence interval (CI) = 1.26–3.82), individuals with knee osteoarthritis (OR = 3.07, 95% CI = 1.6–5.9), and individuals with moderate to severe pain (OR = 5.02, 95% CI = 2.23–11.28) were more likely to report combined use of PS and NPS modalities. Characteristics associated with individual NPS modalities varied greatly.

Conclusion

Only one-third of older adults with persistent pain reported pain management strategies consistent with current guidelines. Further research is required to understand reasons behind choices, barriers to adherence, and the benefits of multiple modalities that older adults with persistent pain use.

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