Chronic pain is common with aging. Yet, little is known about the attitudes, beliefs, and experiences of older adults with chronic pain regarding opioids, particularly in regard to effects on daily functioning and cognition. This qualitative analysis employed semi-structured interviews in 25 community-dwelling older adults with chronic pain and current or recent prescription opioid use. Interviews focused on perceptions, beliefs, and experiences of living with chronic pain, use of prescription opioids, and the impact of opioids on pain control, cognition, and daily function. Older adults display adaptability and acceptance in living with chronic pain, desire person-centered pain care, approach the risks-benefits of opioids with regards to cognition differently, and perceive stigma as a barrier to effective partnership with clinicians.
AmesH.HestevikC. H.BriggsA. M. (2024). Acceptability, values, and preferences of older people for chronic low back pain management; a qualitative evidence synthesis. BMC Geriatrics, 24(1), 24. https://doi.org/10.1186/s12877-023-04608-4
2.
AndersonT. S.WangB. X.LindenbergJ. H.HerzigS. J.BerensD. M.SchonbergM. A. (2024). Older adult and primary care practitioner perspectives on using, prescribing, and deprescribing opioids for chronic pain. JAMA Network Open, 7(3), Article e241342. https://doi.org/10.1001/jamanetworkopen.2024.1342
3.
BeanD. J.DrylandA.RashidU.TuckN. L. (2022). The determinants and effects of chronic pain stigma: A mixed methods study and the development of a model. The Journal of Pain, 23(10), 1749–1764. https://doi.org/10.1016/j.jpain.2022.05.006
4.
BusseJ. W.WangL.KamaleldinM.CraigieS.RivaJ. J.MontoyaL.MullaS. M.LopesL. C.VogelN.ChenE.KirmayrK.De OliveiraK.OlivieriL.KaushalA.ChaparroL. E.OybermanI.AgarwalA.CoubanR.TsoiL.…GuyattG. H. (2018). Opioids for chronic noncancer pain: A systematic review and meta-analysis. JAMA, 320(23), 2448–2460. https://doi.org/10.1001/JAMA.2018.18472
5.
CherrierM. M.AmoryJ. K.ErsekM.RislerL.ShenD. D. (2009). Comparative cognitive and subjective side effects of immediate-release oxycodone in healthy middle-aged and older adults. The Journal of Pain, 10(10), 1038–1050. https://doi.org/10.1016/j.jpain.2009.03.017
6.
DomenichielloA. F.RamsdenC. E. (2019). The silent epidemic of chronic pain in older adults. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 93(1), 284–290. https://doi.org/10.1016/j.pnpbp.2019.04.006
7.
DowellD.RaganK. R.JonesC. M.BaldwinG. T.ChouR. (2023). CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. MMWR. Recommendations and Reports, 71(3), 1–95. https://doi.org/10.15585/MMWR.RR7103A1
8.
DoyleL.McCabeC.KeoghB.BradyA.McCannM. (2020). An overview of the qualitative descriptive design within nursing research. Journal of Research in Nursing: JRN, 25(5), 443–455. https://doi.org/10.1177/1744987119880234
9.
DublinS.WalkerR. L.GrayS. L.HubbardR. A.AndersonM. L.YuO.CraneP. K.LarsonE. B. (2015). Prescription opioids and risk of dementia or cognitive decline: A prospective cohort study. Journal of the American Geriatrics Society, 63(8), 1519–1526. https://doi.org/10.1111/jgs.13562
10.
FerrellB. A.FerrellB. R.RiveraL. (1995). Pain in cognitively impaired nursing home patients. Journal of Pain and Symptom Management, 10(8), 591–598. https://doi.org/10.1016/0885-3924(95)00121-2
HuangY.-H.PanM.-H.YangH.-I. (2023). The association between gabapentin or pregabalin use and the risk of dementia: An analysis of the national health insurance research database in Taiwan. Frontiers in Pharmacology, 14(1), Article 1128601. https://doi.org/10.3389/fphar.2023.1128601
14.
JassalM.EganG.DahriK. (2020). Opioid prescribing in the elderly: A systematic review. Journal of Pharmacy Technology: jPT: Official Publication of the Association of Pharmacy Technicians, 36(1), 28–40. https://doi.org/10.1177/8755122519867975
15.
JonesC. M. P.DayR. O.KoesB. W.LatimerJ.MaherC. G.McLachlanA. J.BillotL.ShanS.LinC. W. C.WebbM.HamiltonM.AhediH.BarberA.MakW.MathiesonS.PetrovaV.BompointS.MurnionB.YangS. C.…OPAL Investigators Coordinators. (2023). Opioid analgesia for acute low back pain and neck pain (the OPAL trial): A randomised placebo-controlled trial. The Lancet, 402(10398), 304–312. https://doi.org/10.1016/S0140-6736(23)00404-X
16.
KambojS. K.TookmanA.JonesL.CurranV. H. (2005). The effects of immediate-release morphine on cognitive functioning in patients receiving chronic opioid therapy in palliative care. Pain, 117(3), 388–395. https://doi.org/10.1016/j.pain.2005.06.022
17.
KrebsE. E.GravelyA.NugentS.JensenA. C.DeRonneB.GoldsmithE. S.KroenkeK.BairM. J.NoorbaloochiS. (2018). Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical trial. JAMA, 319(9), 872–882. https://doi.org/10.1001/JAMA.2018.0899
18.
LaChapelleD. L.LavoieS.BoudreauA. (2008). The meaning and process of pain acceptance. Perceptions of women living with arthritis and fibromyalgia. Pain Research and Management: The Journal of the Canadian Pain Society, 13(3), 201–210. https://doi.org/10.1155/2008/258542
19.
LeeuwM.GoossensM. E. J. B.LintonS. J.CrombezG.BoersmaK.VlaeyenJ. W. S. (2007). The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine, 30(1), 77–94. https://doi.org/10.1007/s10865-006-9085-0
20.
ManogharanS.KongstedA.FerreiraM. L.HancockM. J. (2017). Do older adults with chronic low back pain differ from younger adults in regards to baseline characteristics and prognosis?European Journal of Pain, 21(5), 866–873. https://doi.org/10.1002/ejp.989
21.
McCrackenL. M.VowlesK. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69(2), 178–187. https://doi.org/10.1037/a0035623
22.
O’BrienB. C.HarrisI. B.BeckmanT. J.ReedD. A.CookD. A. (2014). Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine, 89(9), 1245–1251. https://doi.org/10.1097/ACM.0000000000000388
23.
OhGy.MogaD. C.FardoD. W.AbnerE. L. (2022). The association of gabapentin initiation and neurocognitive changes in older adults with normal cognition. Frontiers in Pharmacology, 13(1), Article 910719. https://doi.org/10.3389/fphar.2022.910719
24.
PatelK. V.GuralnikJ. M.DansieE. J.TurkD. C. (2013). Prevalence and impact of pain among older adults in the United States: Findings from the 2011 national health and aging trends study. Pain, 154(12), 2649–2657. https://doi.org/10.1016/j.pain.2013.07.029
25.
PuustinenJ.NurminenJ.LöppönenM.VahlbergT.IsoahoR.RäihäI.KiveläS. L. (2011). Use of CNS medications and cognitive decline in the aged: A longitudinal population-based study. BMC Geriatrics, 11(1), 70. https://doi.org/10.1186/1471-2318-11-70
26.
RustøenT.WahlA. K.HanestadB. R.LerdalA.PaulS.MiaskowskiC. (2005). Age and the experience of chronic pain: Differences in health and quality of life among younger, middle-aged, and older adults. The Clinical Journal of Pain, 21(6), 513–523. https://doi.org/10.1097/01.ajp.0000146217.31780.ef
27.
SchieberL. Z.GuyG. P.SethP.LosbyJ. L. (2020). Variation in adult outpatient opioid prescription dispensing by age and sex—United States, 2008–2018. MMWR. Morbidity and Mortality Weekly Report, 69(11), 298–302. https://doi.org/10.15585/MMWR.MM6911A5
28.
VaismoradiM.TurunenH.BondasT. (2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing and Health Sciences, 15(3), 398–405. https://doi.org/10.1111/nhs.12048
29.
WarnerN. S.HansonA. C.SchulteP. J.HabermannE. B.WarnerD. O.MielkeM. M. (2022). Prescription opioids and longitudinal changes in cognitive function in older adults: A population-based observational study. Journal of the American Geriatrics Society, 70(12), 3526–3537. https://doi.org/10.1111/JGS.18030
30.
WarnerN. S.MielkeM. M.VerdoornB. P.KnopmanD. S.HootenW. M.HabermannE. B.WarnerD. O.KernP. E. (2023). Pain, opioid analgesics, and cognition: A conceptual framework in older adults. Pain Medicine, 24(2), 171–181. https://doi.org/10.1093/pm/pnac113
31.
WegierP.VarenbutJ.BernsteinM.LawlorP. G.IsenbergS. R. (2020). “No thanks, I don’t want to see snakes again”: A qualitative study of pain management versus preservation of cognition in palliative care patients. BMC Palliative Care, 19(1), 182. https://doi.org/10.1186/s12904-020-00683-1
32.
Welch-ColtraneJ. L.WachnikA. A.AdamsM. C. B.AvantsC. R.BlumsteinH. A.BrooksA. K.FarlandA. M.JohnsonJ. B.PariyadathM.SummersE. C.HurleyR. W. (2021). Implementation of individualized pain care plans decreases length of stay and hospital admission rates for high utilizing adults with sickle cell disease. Pain Medicine, 22(8), 1743–1752. https://doi.org/10.1093/pm/pnab092
33.
YouD. S.ZiadniM. S.HettieG.DarnallB. D.CookK. F.Von KorffM. R.MackeyS. C. (2022). Comparing perceived pain impact between younger and older adults with high impact chronic pain: A cross-sectional qualitative and quantitative survey. Frontiers in Pain Research, 3(1), Article 850713. https://doi.org/10.3389/fpain.2022.850713
34.
ZhuZ.ChiarottoA.EnthovenW. T. M.Bierma-ZeinstraS. M. A.KoesB. W. (2023). Does pain medication influence outcomes in elderly people seeking care for back pain? BACE cohort study. European Journal of Pain (London, England), 27(5), 611–623. https://doi.org/10.1002/ejp.2084
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