• Alex D Federman, Ann Litke, and R Sean Morrison.
• Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. alex.federman@mssm.edu
• Am J Geriatr Pharmacother. 2006 Dec 1;4(4):306-15.

BackgroundPain is a common, troubling symptom of various disorders, chronically affecting up to 11% of adults in the general public. Despite a growing emphasis on improving the quality of pain management and the increasing use of analgesics over the past 20 years, pain remains undertreated for patients in a variety of clinical settings. Elderly patients, in particular, have disproportionately low rates of adequate pain control compared with younger patients.ObjectiveThe goal of this article was to determine the association of age with analgesic use in outpatient settings.MethodsCross-sectional analyses of data from the 1999-2002 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were conducted. We modeled use of NSAIDs or opioids as a function of age using multivariable logistic regression. Adults (aged > or =18 years) with pain and an inflammatory or mechanical disorder of the back or joint seen in outpatient settings in the United States were included in the study.ResultsFrom 1999 to 2002, 7273 outpatient hospital and community-based visits to physicians were recorded for adults with pain and a diagnosis of a back or joint disorder, representing approximately 34 million visits per year. Acetaminophen, NSAIDs, and opioids were reported for 3.7%, 28.8%, and 17.3% of visits, respectively. Individuals aged > or =75 years were more likely than those aged 18 to 54 years to use NSAIDs (adjusted odds ratio, 1.50; 95% CI, 1.15-1.97), an effect of the increasing use of cyclooxygenase-2 inhibitors among older patients. Older patients were less likely to use opioids (adjusted odds ratio, 0.49; 95% CI, 0.32-0.75).ConclusionsIn outpatient settings, elderly patients with pain and back or joint disorders tend to use NSAIDs more often and opioids less often than younger patients, suggesting that older patients may be receiving a poorer quality of pain management in outpatient settings.

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