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. 2025 Mar;42(3):267-274.
doi: 10.1007/s40266-025-01181-w. Epub 2025 Feb 26.

Dementia Medications and Their Association with Pain Medication Use in Medicare Beneficiaries with Alzheimer's Disease/Alzheimer's Disease-Related Dementias and Chronic Pain

Sadaf Arefi Milani  1 , Jordan Westra  2 , Yong-Fang Kuo  3 , Brian Downer  4 , Mukaila A Raji  5
Affiliations

Dementia Medications and Their Association with Pain Medication Use in Medicare Beneficiaries with Alzheimer's Disease/Alzheimer's Disease-Related Dementias and Chronic Pain

Sadaf Arefi Milani et al. Drugs Aging. 2025 Mar.

Abstract

Introduction: Chronic pain is prevalent among older adults with Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD). Memantine and acetylcholinesterase inhibitors (ACHEI; donepezil, rivastigmine, and galantamine) are approved for the treatment of dementia symptoms and may also have analgesic properties. However, findings on the clinical utility of these dementia medications for chronic pain treatment are mixed, and little is known about differences in the use of pain medication according to whether an older adult with AD/ADRD is using dementia medications.

Methods: We selected a 20% national sample of Medicare enrollees with a diagnosis of AD/ADRD and chronic pain in 2020. We calculated the odds of having any pain management prescription (opioids, serotonin and norepinephrine reuptake, gapapentinoids, or non-steroidal anti-inflammatory drugs), having an opioid prescription, and having a long-term (≥ 90 days) opioid prescription, by dementia medication (none, memantine, ACHEI, or memantine and ACHEI).

Results: Among 103,564 patients, 5.5% received a memantine prescription, 14.4% received an ACHEI prescription, and 8.6% received a prescription for both. Over 70% of all patients had a pain management prescription. The percentage of patients who had an opioid prescription ranged from 54.5% for those without a dementia medication prescription to 44.0% for those with a prescription for both memantine and ACHEI. Similarly, the percentage of patients who had a long-term opioid prescription was highest for those without a dementia medication prescription (12.2%) and lowest for those with a prescription for both memantine and ACHEI (8.8%). Having a prescription for memantine only was associated with lower odds of any pain management prescription (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.88-1.00; p < 0.05). Having a prescription for either memantine (OR: 0.79; 95% CI 0.75-0.84), ACHEI (OR: 0.85; 95% CI 0.82-0.89), or both (OR: 0.75; 95% CI 0.72-0.79) was associated with lower odds of having an opioid prescription (p < 0.05). Lastly, having a prescription for either memantine (OR: 0.85; 95% CI 0.77-0.94), ACHEI (OR: 0.92; 95% CI 0.86-0.98), or both (OR: 0.83; 95% CI 0.77-0.90) was associated with lower odds of having a long-term opioid prescription.

Discussion: Older adults with co-occurring AD/ADRD and chronic pain who were on dementia medications had lower odds of being prescribed opioid analgesics. Memantine and ACHEIs should be explored as potential opioid-sparing medications for older adults with AD/ADRD, given their relatively safe profiles. Future studies are needed to examine repurposing dementia medications for pain treatment.

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Conflict of interest statement

Declarations. Funding: This work was supported by the National Institute on Aging (NIA)/National Institutes of Health (NIH) (grant nos. K01-AG075254, P30-AG024832, P30-AG059301) and the National Institute on Drug Abuse (grant no. R01‐DA039192). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders had no involvement in the study design, analysis, interpretation, writing of the manuscript, or decision to submit this article for publication. Conflicts of Interest: S.A.M., J.W., Y.F.K., B.D., and M.R. declare that they have no conflicts of interest that might be relevant to the contents of this manuscript. Ethics Approval: Our use of the 20% National Medicare data was approved by the University of Texas Medical Branch Institutional Review Board (16-0247). Consent: Not applicable. Data Availability Statement: The data used in this study are not publically available and require a data use agreement (DUA) from the Centers for Medicare & Medicaid Services. Code Availability: Not applicable. Author Contributions: S.A.M., Y.F.K., and M.R. were involved in the conceptualization, design, interpretation of the results, and editing of the manuscript. B.D. contributed to the interpretation of the results and editing of the manuscript. J.W. conducted data analysis. All authors edited and approved the final version of the manuscript.

Figures

Fig. 1
Fig. 1
Odds of having an opioid prescription, by dementia medication use (reference group: no dementia medication; n = 103,564)
See this image and copyright information in PMC

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