Alzheimer’s disease and related dementias (ADRD), pain and chronic complex conditions (CCC) often co-occur leading to polypharmacy and with potential inappropriate medications (PIMs) use, are important risk factors for adverse drug reactions and hospitalizations in older adults. Many US veterans are at high risk for persistent pain due to age, injury or medical illness. Concerns about inadequate treatment of pain—accompanied by evidence about the analgesic efficacy of opioids—has led to an increase in the use of opioid medications to treat chronic pain in the Veterans Health Administration (VHA) and other healthcare systems. This study aims to investigate the relationship between receipt of pain medications and centrally (CNS) acting PIMs among veterans diagnosed with dementia, pain intensity, and CCC 90-days prior to hospitalization. The final analytic sample included 96,224 (81.7%) eligible older veterans from outpatient visits between October 2012–30 September 2013. We hypothesized that veterans with ADRD, and severe pain intensity may receive inappropriate pain management and CNS-acting PIMs. Seventy percent of the veterans, and especially people with ADRD, reported severe pain intensity. One in three veterans with ADRD and severe pain intensity have an increased likelihood for CNS-acting PIMs, and/or opioids. Regular assessment and re-assessment of pain among older persons with CCC, patient-centered tapering or discontinuation of opioids, alternatives to CNS-acting PIMs, and use of non-pharmacological approaches should be considered.

中文翻译：

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痴呆症患者的疼痛、复杂的慢性病和潜在的不适当药物治疗。利用退伍军人健康管理局的数据制定疼痛治疗计划的经验教训

阿尔茨海默氏病和相关痴呆症 (ADRD)、疼痛和慢性复杂性疾病 (CCC) 经常同时发生，导致多种用药以及潜在的不当药物 (PIM) 使用，是老年人药物不良反应和住院治疗的重要危险因素。由于年龄、受伤或疾病，许多美国退伍军人面临持续疼痛的高风险。对疼痛治疗不充分的担忧，以及阿片类药物镇痛功效的证据，导致退伍军人健康管理局 (VHA) 和其他医疗保健系统越来越多地使用阿片类药物来治疗慢性疼痛。本研究旨在调查住院前 90 天诊断为痴呆、疼痛强度和 CCC 的退伍军人中接受止痛药物与中枢 (CNS) 作用 PIM 之间的关系。最终分析样本包括 2012 年 10 月至 2013 年 9 月 30 日期间门诊就诊的 96,224 名 (81.7%) 符合资格的老年退伍军人。我们假设患有 ADRD 和严重疼痛的退伍军人可能接受了不适当的疼痛管理和中枢神经系统作用的 PIM。70% 的退伍军人，尤其是患有 ADRD 的退伍军人，报告了严重的疼痛强度。三分之一患有 ADRD 和严重疼痛的退伍军人中，使用具有中枢神经系统作用的 PIM 和/或阿片类药物的可能性增加。应考虑定期评估和重新评估患有 CCC 的老年人的疼痛，以患者为中心逐渐减少或停用阿片类药物，替代中枢神经系统作用的 PIM，以及使用非药物方法。