Management of persistent pain in older adults: the MOBILIZE Boston Study

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.