Use of potentially inappropriate pain-related medications in older adults with painful neuropathic disorders

Background:Although older adults with painful neuropathic disorders (PNDs) would appear to be at elevated risk for receiving potentially inappropriate pain-related medications, the extent of such drug use in this population is unknown.Objective:The goal of this study was to assess the use of potentially inappropriate pain-related medications among patients with PNDs aged ≥65 years.Methods:Using a large, integrated US health insurance database, we identified all persons aged ≥65 years with ≥2 medical encounters involving diagnoses of PNDs during calendar year 2000. Patients with <30 days of continuous eligibility for health benefits during the study year were excluded from the sample. Use of potentially inappropriate pain-related medications (as defined by the 1997 Beers criteria) was then examined based on information contained in paid pharmacy claims for all remaining patients.Results:We identified 22,668 patients with PNDs aged ≥65 years (mean [SD] age, 73.9 [6.0] years; 58.6% female). Almost one half (11,233 [49.6%]) of patients received ≥1 potentially inappropriate pain-related medication, including propoxyphene (26.7%) and amitriptyline (10.2%). Women were more likely than men to receive these medications (54.2% vs 43.0%, respectively; P < 0.01), and use increased with age (47.6%, 51.8%, and 52.8% in those aged 65–74 years, 75–84 years, and ≥85 years, respectively; overall comparison, P < 0.01). Among patients with only 1 PND, the use of potentially inappropriate medications was highest among those with postherpetic neuralgia (70.1%).Conclusions:Use of potentially inappropriate pain-related medications among older adults with PNDs is common. Further research is needed to ascertain whether the benefits of these agents outweigh their risks in this population.