Characterizing Opioid Response in Older Veterans in the Post-Acute Setting

Abstract

Background: Opioids often are used in post-acute care (PAC) settings, although there is a lack of evidence of sustained pain reduction and improved function. There are subgroups of individuals whose pain does not respond well to opioids yet report these agents as highly beneficial. We aimed to classify opioid responsiveness among veterans residing in a US Department of Veterans Affairs community living center PAC unit. Methods: This observational, cross-sectional study used barcode medication administration data followed by retrospective chart review. We determined opioid responsiveness along a continuum during 4 nonconsecutive days in 2016 and 2017. We defined opioid responsiveness as the mean change in pre- and postopioid pain ratings using the 0 to 10 scale over the 24-hour observation period (ie, mean ∆ score). The chart review identified correlates of opioid responsiveness adjusting for mean pre-opioid pain ratings. Results: Among the 41 residents who received opioids for at least moderate pain (≥ 4 of 10), the average response was highly variable (range, 0.5 - 6.3). Response did not correlate with demographic variables, indication for admission, or medical comorbidities, including cancer diagnosis. The presence of any psychiatric diagnosis ( P = .03), pain service consult ( P = .03), and higher opioid dosage ( P = .002) was significantly associated with poorer response. Conclusions: This pilot study classified opioid response on a continuum using a scalable administrative data source. Despite receiving higher dosages and more specialist consultations, some veterans’ pain responds poorly to opioids. Psychiatric comorbidity seems to increase this risk. Future studies in larger, more representative populations are necessary to confirm these findings to develop personalized pain management strategies that mitigate risks of opioids. its This article may discuss unlabeled or inves- tigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combina- tions—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.