Prevalence and Treatment of Neuropathic Pain Diagnoses Among U.S. Nursing Home Residents

Attah K. Mbrah; Anthony P. Nunes; Anne L. Hume; Danni Zhao; Bill M. Jesdale; Carol Bova; Kate L. Lapane

Disclosures

Pain. 2022;163(7):1370-1377. 

In This Article

Abstract and Introduction

Abstract

Neuropathic pain is a common condition experienced by older adults. Prevalence estimates of neuropathic pain and descriptive data of pharmacologic management among nursing home residents are unavailable. We estimated the prevalence of neuropathic pain diagnoses and described the use of pain medications among nursing home residents with possible neuropathic pain. Using the Minimum Data Set 3.0 linked to Medicare claims for residents living in a nursing home on November 30, 2016, we included 473,815 residents. ICD-10 codes were used to identify neuropathic pain diagnoses. Identification of prescription analgesics/adjuvants was based on claims for the supply of medications that overlapped with the index date over a 3-month look-back period. The prevalence of neuropathic pain was 14.6%. Among those with neuropathic pain, 19.7% had diabetic neuropathy, 27.3% had back and neck pain with neuropathic involvement, and 25.1% had hereditary or idiopathic neuropathy. Among residents with neuropathic pain, 49.9% received anticonvulsants, 28.6% received antidepressants, 19.0% received opioids, and 28.2% had no claims for analgesics or adjuvants. Resident characteristics associated with lack of medications included advanced age, dependency in activities of daily living, cognitive impairment, and diagnoses of comorbid conditions. A diagnosis of neuropathic pain is common among nursing home residents, yet many lack pharmacologic treatment for their pain. Future epidemiologic studies can help develop a more standard approach to identifying and managing neuropathic pain among nursing home residents.

Introduction

Neuropathic pain is defined as "pain caused by a lesion or disease of the somatosensory nervous system."[24] Various lesions in the peripheral or central nervous system can lead to neuropathic pain, which is characterized as persistent or intermittent burning, prickling, or lancinating pain that may occur spontaneously or be evoked by stimuli.[2,16] Common causes include diabetes, stroke, herpes zoster, trigeminal neuralgia, and nerve compression and entrapment syndromes.[2,16,41] Owing to its broad etiology and association with multiple pain processes, neuropathic pain is challenging to diagnose and treat.[7,12] Those suffering with ineffectively treated neuropathic pain have significant detriments to their health-related quality of life.[7,25,30]

The prevalence of the diseases that cause neuropathic pain increase with age; older individuals are more likely to have neuropathic pain.[34] However, owing to the lack of a standardized approach to identify neuropathic pain in observational studies, estimates of its prevalence in various populations are highly variable.[35,40] Estimates have relied on the use of validated screening instruments[5] or review of medical records in addition to observed signs and symptoms.[39] The prevalence of neuropathic pain has been estimated among individuals with specific conditions that cause neuropathic pain.[20,35] Between 21% and 26% of individuals with type 2 diabetes have painful diabetic neuropathy.[1,11] Among those with chronic low back pain, neuropathic pain is the predominant complaint (37%).[19]

There is limited information on the prevalence and characteristics of neuropathic pain and neuropathic pain–associated conditions among nursing home residents. Studies among Dutch nursing home residents have estimated the prevalence of neuropathic pain to be between 2.4% and 10.9%.[41,42] These available studies have small sample sizes and may have limited generalizability to nursing homes in the United States. Older individuals also tend to have multiple comorbid conditions that complicate the pharmacologic management of their pain.[34] Information on the use of drug regimens among U.S. nursing home residents with neuropathic pain is unavailable. This study sought to address this research gap. The study objectives were to (1) estimate the prevalence of neuropathic pain among nursing home residents, (2) describe the use of pain medications among persons with neuropathic pain, and (3) identify the characteristics associated with lack of pharmacologic pain management among individuals with neuropathic pain.

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