• Charlotte Griffioen, Bettina S Husebo, Elisabeth Flo, Caljouw Monique A A MAA Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands., and Wilco P Achterberg.
• Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
• Pain Med. 2019 Jan 1; 20 (1): 50-57.

BackgroundAlthough proper pain treatment may require opioids, discussion continues about possible undertreatment or overtreatment in persons with advanced dementia.ObjectiveTo investigate the prevalence of pain, frequency of opioid prescription use, and factors associated with strong opioid prescription use in nursing homes.DesignCross-sectional study.Setting And SubjectsEighteen Norwegian nursing homes; 327 persons with advanced dementia and behavioral disturbances participated.MethodsPotential factors associated with strong opioid prescription use were assessed: demographics (age, gender), medical conditions (comorbidity, number of medications), pain (Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale ≥ 3, pain-related diagnoses, analgesic prescription use), functioning (activities of daily living, Mini-Mental State Examination) and behavior (Neuropsychiatric Inventory-Nursing Home version, Cohen-Mansfield Agitation Inventory). Factors with P < 0.10, age, and gender were included in multivariate regression analysis.ResultsThe prevalence of moderate to severe pain was 62.1%. Of all participants, 19.3% (N = 63) were prescribed opioids, and of these, 79.4% (N = 50) were still in pain; 66.7% of the opioid prescriptions were less than or equal to the lowest dosage of fentanyl patches (12 mcg/h) or buprenorphine (5 or 10 mcg/h). Pain (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.12-1.42), total number of pain-related diagnoses (OR = 1.47, 95% CI = 1.14-1.90), and depression and anxiety (OR = 1.05, 95% CI = 1.01-1.11) were positively associated with an opioid prescription. Stroke was negatively associated (OR = 0.43, 95% CI = 0.19-0.99).ConclusionsStrong opioid prescription use was mainly associated with pain. However, in this population, despite the relatively prevalent use of strong prescription opioids, pain was still prevalent. This emphasizes the challenge of proper pain treatment and need for regular evaluation of pain and pain management.

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