Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Sep;25(9):105077.
doi: 10.1016/j.jamda.2024.105077. Epub 2024 Jun 8.

Effectiveness of Short-Acting Opioid Escalation vs Initiation of a Long-Acting Opioid in Nursing Home Residents

Affiliations
Observational Study

Effectiveness of Short-Acting Opioid Escalation vs Initiation of a Long-Acting Opioid in Nursing Home Residents

Anthony P Nunes et al. J Am Med Dir Assoc. 2024 Sep.

Abstract

Objectives: Modifications to opioid regimens for persistent pain are typically made after an initial period of short-acting opioid (SAO) use. Regimen changes may include an escalation of the SAO dosage or an initiation of a long-acting opioid (LAO) as a switch or add-on therapy. This study evaluates the comparative effectiveness between these alternative regimens in nursing home residents.

Design: A retrospective observational cohort analysis of US long-stay nursing home residents.

Setting and participants: Nursing home resident data were obtained from the national Minimum Dataset (MDS) version 3.0 and linked Medicare data, 2011-2016.

Methods: Opioid regimen changes were identified using Part D dispensing claims to identify dosage escalation of SAOs, initiation of an LAO, or a switch to an LAO. Outcomes included indices of pain occurrence, frequency, and severity reported on the earliest MDS assessment within 3 months following the opioid regimen change. Resident attributes were described by opioid regimen cohort. Prevalence ratios of pain and depression indices were quantified using doubly robust inverse probability of treatment (IPT)-weighted log-binomial regression.

Results: The study cohorts included 2072 SAO dose escalations, 575 LAO add-on initiations, and 247 LAO switch initiations. After IPT weighting, we observed comparable effects on pain and mood across the opioid regimen cohorts. A substantial number of residents continued to report frequent/constant pain (36% in SAO Escalation Cohort, 42% in LAO Add-on Cohort, 42% in the LAO Switch Cohort). The distribution of depressive symptoms was similar regardless of the opioid regimen change.

Conclusions and implications: Initiation of an LAO as an add-on to SAO or a switch from SAO had comparable effects on pain and mood to SAO dose escalation without initiation of an LAO. Although fewer residents reported any pain after the regimen change, persistent pain was reported by most residents.

Keywords: Depression; long-acting opioids; nursing home; pain; short-acting opioids.

PubMed Disclaimer

Conflict of interest statement

Disclosure K.L.L. is a consultant for Exponent. A.P.N. is a consultant for Optum Epidemiology. The other authors declare no conflicts of interest.

Similar articles

References

    1. Hunnicutt JN, Ulbricht CM, Tjia J, and Lapane KL, Pain and pharmacologic pain management in long-stay nursing home residents. Pain, 2017. 158(6): p. 1091–1099. - PMC - PubMed
    1. Cole CS, et al., Pain and Associated Factors in Nursing Home Residents. Pain Manag Nurs, 2023. 24(4): p. 384–392. - PMC - PubMed
    1. Abdulla A, et al., Guidance on the management of pain in older people. Age Ageing, 2013. 42 Suppl 1: p. i1–57. - PubMed
    1. Cole CS, et al., Prevalence and Factors Associated with Pain in Nursing Home Residents: A Systematic Review of the Literature. J Am Med Dir Assoc, 2022. 23(12): p. 1916–1925 e1. - PubMed
    1. Erdal A, et al., Associations between pain and depression in nursing home patients at different stages of dementia. J Affect Disord, 2017. 218: p. 8–14. - PubMed

Publication types

Substances