Opioids and Adjuvants for Pain in Nursing Home Residents with Cancer

阿片类药物和佐剂用于治疗癌症疗养院居民的疼痛

基本信息

批准号：
8953021
负责人：
Kate L Lapane
金额：
$ 21.86万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-07-01 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8953021
关键词：
Absence of pain sensation Adjuvant Adjuvant Analgesic Admission activity Adverse effects Adverse event Age Agreement Americas Analgesics Anticonvulsants Antidepressive Agents Attenuated Breast Caring Certification Clinical Practice Guideline Clinical Research Comorbidity Constipation Data Data Set Data Sources Databases Demographic Aging Diagnosis Dose Drug Kinetics Effectiveness Elderly Elements Eligibility Determination Ensure Ethnic Origin Evaluation Fracture Frail Elderly Future Gap Junctions Gender Goals Healthcare Hemorrhage Housing Impaired cognition Institute of Medicine (U.S.)Intervention Intervention Studies Knowledge Longitudinal Studies Lung Malignant Neoplasms Medicare Medicare claim Medicare/Medicaid Medication Management Mental Depression Methods Morphine National Cancer Institute Nursing Homes Opioid Outcome Pain Pain management Patient Care Patients Pattern Perception Pharmacodynamics Population Population Characteristics Prostate Provider Race Randomized Regimen Relative (related person)Reporting Research Research Design Risk Role Route Sample Size Shapes Sleeplessness Structural Models Surveys System Time Update Vulnerable Populations Woman Work age related aging population base beneficiary cancer pain cancer type chronic pain crosslink design dosage duloxetine end of life experience falls gastrointestinal improved interest public health relevance research study sound treatment effect uptake

项目摘要

DESCRIPTION (provided by applicant): Nearly 1/3rd of Medicare beneficiaries with cancer will receive care in a nursing home (NH). Our preliminary work revealed that among NH residents with cancer, 28.3% had daily pain with 13.5% experiencing severe pain and 61.3% with moderate pain. Opioid use was common for those with daily pain, despite the potential for significant adverse effects such as insomnia, depression, constipation and cognitive impairment. The extent to which adjuvants to analgesia may be used to improve the level of analgesia and ultimately reduce opioid dosage has not been explored in this vulnerable population. The proposed work uses a contemporaneous dataset to provide longitudinal descriptions of the management of pain in newly admitted NH residents with cancer. We propose merging elements of the following existing databases: the Minimum Data Set (MDS), Medicare eligibility and claims data (Part A, B & D), and the Certification and Survey Provider Enhanced Reporting (CASPER) system. Using state of the art analytic methods such as marginal structural models, the specific aims are to: 1) Describe the pattern of analgesic use in terms of "morphine equivalents", route of administration, and use of adjuvants to analgesia in patients newly admitted to NHs with cancer and to compare the level of daily pain, analgesia use, and adjuvant use as a function of age, gender, race/ethnicity and level of cognitive impairment.; 2) Evaluate the extent to which pharmacologic management of pain including the uptake of adjuvants to analgesia intensifies over time in NH residents with cancer; and 3) Quantify the association between adjuvants to pain medication and reduction of opioid dose and potential adverse effects (e.g. constipation). The National Cancer Institute is interested in pursuing clinical research to evaluate the role of adjuvants to chronic pain management (PA-14-225). The proposed exploratory work is a necessary precursor prior to design of an RO1 for the NH context. No studies have attempted to characterize the longitudinal experience of pain and use of opioids and adjuvants in NH residents with cancer. Evaluation of the changes in pain, pharmacologic pain treatments, use of adjuvants and outcomes in a contemporaneous national dataset of NH residents with cancer will form the basis of a scientifically sound larger randomized controlled experiment of the use of adjuvants in pain management in NH settings.

描述（由申请人提供）：近 1/3 的癌症医疗保险受益人将在疗养院 (NH) 接受护理。我们的初步研究显示，在 NH 患有癌症的居民中，28.3% 的人每天都会感到疼痛，其中 13.5% 的人经历严重疼痛和疼痛。 61.3% 的人患有中度疼痛，尽管阿片类药物可能会带来失眠、抑郁、便秘和认知障碍等不良影响，但对于那些每天都会感到疼痛的人来说，使用阿片类药物很常见。镇痛佐剂可用于提高镇痛水平并最终减少阿片类药物的剂量，但尚未在这一弱势群体中进行探索。拟议的工作使用同期数据集来提供新入院的癌症患者疼痛管理的纵向描述。我们建议合并以下现有数据库的元素：最小数据集 (MDS)、医疗保险资格和索赔数据（A、B 和 D 部分）以及认证和调查提供商增强报告(CASPER) 系统。使用最先进的分析方法，例如边际结构模型，具体目标是： 1) 根据“吗啡当量”、给药途径和镇痛佐剂的使用来描述镇痛药的使用模式。在新入院的癌症患者中，比较每日疼痛水平、镇痛使用和辅助使用与年龄、性别、种族/民族和认知障碍水平的关系。 2) 评估患有癌症的 NH 居民随着时间的推移，药物治疗疼痛的程度，包括镇痛佐剂的使用强度；以及 3) 量化佐剂与药物和阿片类药物剂量减少以及潜在不良反应（例如便秘）之间的关联。国家癌症研究所有兴趣进行临床研究，以评估佐剂对慢性疼痛治疗的作用（PA-14-225）。在为 NH 背景设计 RO1 之前，没有研究试图描述 NH 癌症居民的疼痛和阿片类药物和佐剂的使用的纵向经历，评估疼痛、药物疼痛治疗的变化。同期全国新罕布什尔州居民癌症数据中佐剂的使用和结果将构成在新罕布什尔州设置的在疼痛管理中使用佐剂的科学合理的大型随机对照实验的基础。