Low back pain improvement in older veterans
A research published in The American Pain Society’s Journal of Pain has reported that the use of opioids for pain management, certain mental health conditions, and some pain-related diagnoses were associated with a lower improvement in older military veterans. Aging veterans are at high risk for persistent chronic pain, although little is known regarding the underlying factors associated with positive and negative outcomes over time. Older adults also have the highest prevalence of long-term use of pain medication, including prescription opioids.
In a study, investigators at Veterans Affairs Center to Improve Veterans Involvement in Care and Oregon Health & Science University sought to identify clinical and demographic factors associated with pain intensity symptom improvements in a national cohort of veterans age 65 and older. The researchers suspected that older age and comorbid mental health disorders would be associated with less improvement in pain conditions over time.
The study included 130000 veterans receiving treatment from VA system who had persistently elevated numeric rating scale scores and had not been prescribed opioid painkillers in the 12 months before joining the study. Participants were scored on the percentage decrease over 12 months in average pain intensity scores relative to average baseline pain intensity score and time to sustained improvement in average pain intensity scores. Almost two-thirds met criteria for sustained improvement during the 12-month follow-up. Initiation of opioid therapy was associated with lower likelihood for sustained improvement. Other factors linked with poor improvement were service-connected disability and mental health problems, chronic low back pain, neuropathy and fibromyalgia.
According to Steven K. Dobscha, lead author and professor of psychiatry at Oregon Health and Sciences University, "We found that older veterans often show improvements in pain intensity over time, and that opioid prescriptions, mental health conditions and certain pain diagnoses are associated with lower likelihood of improvement." He added, "Further, the oldest group of veterans within the sample demonstrated the most improvements in pain intensity. This supports prior research indicating that as age increases, patterns and perceptions of pain may change and suggests that many older people with pain adjust and cope better over time."
The study authors say their findings call for further characterization of heterogeneity in pain outcomes in older adults, in particular further analysis of the relationship between prescription opioids and treatment outcomes.