The Pains of aging : the use of opioids in older adults with osteoarthritis

Abstract

Background/Purpose: Osteoarthritis is the most common form of arthritis in the U.S. affecting over 12 million people over the age of 65 at a cost of approximately $15.5 billion dollars per year. Osteoarthritis is a chronic, progressive, and disabling disease that often requires advanced practice nurses to develop pain management treatment strategies that often include the use of opioids. The purpose of this study was to evaluate the impact of newly prescribed opioids on perceived pain, as measured by the Verbal Numeric Scale (VNS), and overall health status, as measured by the Arthritis Impact Measurement Scales (AIMS2) for older adults diagnosed with osteoarthritis who have failed acetaminophen and NSAID therapy. Framework: The theoretical framework to guide this study was the Adapted Integrated Approach to Symptom Management (IASM). This framework focuses on the person's perception, evaluation, and response to a disease symptom or cluster of symptoms, including physiological, psychological, and behavioral components. Design/Methods: A repeated measures design was utilized. A convenience sample (n=7) was obtained from a small pain clinic located in the Midwest. Demographic data and family history of osteoarthritis was obtained for subjects aged 65 years or greater who were being prescribed a first time opioid after acetaminophen and NDSAIDS failure. The Arthritis Impact Measurements Scale (AIMS2) and a verbal numeric pain scale (VNS) were administered at enrollment and repeated 30 days after opioid initiation. Findings: The average age of subjects was 78.14 (range 65 to 88, SD 7.17). They were self-described as having the diagnosis of osteoarthritis for an average of 28.14 years. (range 2 to 60, SD 22.30). One hundred percent of subjects described a slight decrease in perceived pain 30 days after the initiation of opioids, but overall decreases did not reach a level of statistical significance (p=.223, .236, .223, .234, .168). The paired Wilcoxon Signed Rank test of the three component health status model for arthritis impact revealed a statistically significant improvement in physical functioning after the initiation of opioids, z=-2.197, p<.05, (r=.58), an overall improvement in psychological status, z=-2.023, p<.05, (r=.54), and a small improvement in the symptoms of pain, although not reaching a level of significance, z=-1.781, p<.075, (r=0.47). These findings are not generalizable due to the small number of subjects. 2 Conclusions/Clinical Relevance: Advanced practice nurses who prescribe opioids to subjects diagnosed with osteoarthritis must assist subjects in understanding the disease process. Evaluation of symptom management strategies related to the use of opioids is paramount in improving the quality of life for subjects living with the disease. Advanced practice nurses play a pivotal role in understanding the positive and negative effects of perceptions of pain, and have an essential role in clinical efforts to improve physical and psychological functioning in patients diagnosed with osteoarthritis.