Undertreated pain: Trends over time for older adults with and without cancer.

Abstract

15 Background: Concerns about the adequacy of pain management among older adults are increasing. We examined calendar year (CY) trends in prescription medication (Rx) use by older adults with and without cancer who reported pain interference with normal activities. Methods: Using the 2007-2012 SEER-Medicare Health Outcomes Survey (MHOS) database with a unique linkage to Part D prescription claims data, we selected MHOS participants with Part D coverage who were within 5 years of cancer diagnosis or without cancer history. We used Rx claims to characterize use of opioids, non-opioid analgesics, local anesthetics and anti-epileptics during the 90 days post survey. Participant reported pain-related activity limitations within the past 30 days (pain interference) were summarized as severe, moderate, or none. We applied multivariable logistic regression to determine associations of Rx use with CY, cancer status, and pain interference, controlling for socio-demographics, chronic conditions, plan type and Part D Low Income Subsidy. Adjusted outcome levels were predicted based on the regression coefficients. Results: In the total sample (N = 15,624), pain Rx was used by 30%, with 20% receiving opioids. Severe or moderate pain interference with activities was reported by 23% and 46%, respectively. Among respondents with cancer (N = 9,105), 49% reporting severe (28% moderate) pain interference received any pain Rx; 37% & 18% used opioids, respectively. For those without cancer, adjusted pain Rx use rates were significantly lower in all categories. Pain Rx increased over CY for cancer respondents with moderate pain (25% in 2008 to 31% in 2012; p = .017), but not for those reporting severe pain interference. In addition, pain Rx increased over CY for the cohort without cancer with no pain interference (11% in 2008 to 14% in 2012; p = .027). Conclusions: Despite increased focus on symptom management, the majority of older adults who experienced moderate or severe pain interference did not have Rx for pain management. Efforts to identify and target unmet supportive care needs for Medicare beneficiaries, with and without cancer, are necessary to further improve quality of life.