Research published in The American Pain Society’s Journal of Pain reports that while older military veterans frequently experience improvements in pain intensity over time, use of opioids for pain management, certain mental health conditions, and some pain-related diagnoses were associated with a lower likelihood of improvement.
The article, “Predictors of Improvements in Pain Intensity in a National Cohort of Older Veterans With Chronic Pain,“ notes that the aging veterans are at especially 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 this observational study, investigators at the VA 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 with chronic pain.
Drawing on work supported by the National Institutes of Health, National Institute on Aging, and the Department of Veterans Affairs Veterans Health Administration, the researchers hypothesized that older age and comorbid mental health disorders would be associated with less improvement in pain conditions over time.
The study’s subjects included 12,924 veterans receiving treatment from the Veterans Health Administration who had persistently elevated numeric rating scale scores in 2010, and who had not been prescribed opioid painkiller drugs 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, defined as a 30 percent reduction in three-month scores compared with baseline.
Average relative improvement in pain intensity scores from baseline ranged from 25 percent to 29 percent, and almost two-thirds met criteria for sustained improvement during the study’s 12-month follow-up period. Higher baseline pain intensity and older age were associated with greater likelihood of improvement in pain intensity, whereas a VA service-connected disability and other factors cited above, such as opioid prescription initiation during follow-up, diminished the likelihood of sustained improvement, along with chronic low back pain, neuropathy, and fibromyalgia/myofascial pain diagnoses.
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.
Key study findings include:
• Most older veterans with elevated pain intensity improved over time;
• Higher baseline scores and age were associated with greater likelihood of improvement;
• Certain mental health diagnoses were associated with lower likelihood of improvement;
• Opioid prescriptions were associated with a lower likelihood of sustained pain symptom improvement.
“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,” the study’s lead author, Dr. Steven K. Dobscha, MD, a professor of psychiatry at Oregon Health & Science University, said in a press release.
“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,” he said.
The study also noted that although two-thirds of the study participants experienced reductions in pain intensity over time, a substantial minority did not, and some had exacerbated pain symptoms.
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