Perceived Health Status of Elders Treated with Opioids for Persistent Nonmalignant Pain

Purpose: To explore the relationship between opioid use and perceived health status in older adults aged 65-84 with persistent nonmalignant pain.

Methods: A purposive sample of 31 cognitively intact men and women aged 65-84 years receiving opioid therapy for ≥ 6 months to manage persistent nonmalignant pain.  Data collection included a semi-structured interview that included an initial assessment of cognition using the Short Portable Mental  Status Questionnaire.  All consented participants met the cognitive screening criteria.  The remaining interview collected social and demographic data and perceived health status, pain intensity and functionality, measured by the physical and mental component summary scores of the short form (SF-12v2), 11 point Pain Intensity Scale, and Center for Disease Control Healthy Days-Activities Limitations Module.  Depression was also measured as a covariate, with the Geriatric Depression Scale.

Results: Mean pain intensity scores of 4.0 ± 2.5 (0-10 scale) indicated moderate pain.  Mean Geriatric Depression Scores were 3.7 ± 3.4 indicating no depression. When categorized as depressive symptoms present yes or no, only six participants (19%) had depressive symptoms.  Most elders (77%) reported limitations in their activites of daily living.  Despite limitations the majority managed their personal care (87%) and routine houshold activities (71%) independently.  Mean mental health component scores (MCS) were 50.4 ± 12.0.  Mean physical health component scores (PCS) were 34.2 ± 10.0.  Using national norms for mental and physical component scores of 50.0 ± 10.0, the data suggest the elders had average mental health with lower levels of physical well being.  PCS scores were negatively related to pain intensity (r = -0.44; p < 0.01) while MCS scores did not show a relationshhip (r = -0.22; p = 24).  PCS scores were inversely related to number of comorbid conditions (r = -0.38; p= .24).

Conclusion: This project suggests that pain control with opioid therapy supports functional status among elders.  These findings support national pain treatment guidelines that endorse the use of opioids for the management of persistent nonmalignant pain in the elderly population.  Further studies using prospective designs with larger more diverse study populations are needed to confirm these findings.