Longitudinal non-cancer pain management patterns and risk of adverse outcomes in older adults: Insights from group-based multi-trajectory modelling.

Abstract

Aims: The long-term impact of different non-cancer pain management strategies in older adults remains poorly understood. This population-based retrospective cohort study aimed to identify distinct trajectories of chronic non-cancer pain management and examine their associations with adverse clinical outcomes in older adults, stratified by frailty status.

Methods: Using Taiwan's National Health Insurance database, we included older adults (≥65 years) who initiated non-steroidal anti-inflammatory drugs (NSAIDs) in 2010 and followed them for 8 years. Participants were stratified by frailty status using the multimorbidity frailty index. Group-based multi-trajectory modelling and Cox proportional hazards models were employed to identify distinct trajectories of chronic non-cancer pain management (including medications [i.e., NSAIDs, paracetamol, muscle relaxants and psychotropic agents] and non-pharmacological physical therapy) and to assess the associations between trajectory groups and subsequent clinical outcomes.

Results: Among 24 539 participants (mean age 72.7, 58.9% female), four distinct trajectories were identified: short-term (27.6%), mild (31.9%), moderate (21.7%) and extensive (18.9%) utilization. Compared to the short-term group, the extensive utilization group were significantly associated with higher risks of unplanned hospitalization (adjusted hazard ratio [aHR]: 1.36, 95% confidence interval [CI] 1.24-1.48), all-cause hospitalization (aHR: 1.43, 95% CI 1.35-1.52) and incident dementia (aHR: 1.27, 95% CI 1.04-1.54). For dialysis, only the extensive group was associated with higher risk in the age-sex adjusted model (HR: 2.06, 95% CI: 1.00-4.22), but significance was attenuated after frailty adjustment. No significant differences in all-cause mortality were observed after full adjustment.

Conclusions: These findings highlight that extensive long-term utilization of pain management strategies in older adults is associated with increased risks of adverse outcomes, particularly hospitalizations and incident dementia, especially among fit older adults, emphasizing the need for careful monitoring and personalized approaches to pain management in older populations, balancing effective pain control with minimization of potential long-term risks.