The way older people with chronic pain view opioid use differs from the way their primary care doctors see it, according to a study published Wednesday in JAMA Network Open.
When older adults were asked about the risks of using opioids in the long term, they were more concerned about becoming addicted to the medications, while doctors were more concerned about adverse events like falling, the authors said.
Some other takeaways: Doctors in the study said tapering off the medications is usually warranted, but conversations about deprescribing the medications were often unsuccessful, according to the interview-based study. Older adults and doctors did agree that seeing opioids as a last-resort treatment was OK, the report stated.
In the study, researchers interviewed 18 primary care doctors, along with 29 patients who had received opioid prescriptions at Beth Israel Deaconess Medical Center in Boston. About 80% of the patients had been in pain for more than five years; 90% said they had back or neck pain and almost 80% reported joint pain. Just 17% said their pain resulted from cancer. About half of the participants used oxycodone, 31% were on tramadol and 24% took another type of opioid.
On a 10-point pain scale, the average score was 6.8, the data showed. People with higher pain scores were less likely to be open to the thought of going off the medicine, the authors reported.
About 75% of patients said they would consider lowering their dose if they experienced a fall or if their memory was declining. But only 35% would do it if they were asked to lower the dose based on a medical guideline, the authors reported.
“Safely reducing opioid use among older adults with chronic pain is likely to require the development of materials to foster more informed conversations on the benefits and harms of opioids as well as payment and policy interventions to support the time and teams needed for deprescribing opioids,” the researchers wrote.
