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Cheryl A Sadowski
Anita G Carrie
Ruby E Grymonpre
Colleen J Metge
Philip St.John


Rural, aged, pain, analgesia, opioid, drug and narcotic control



Under-treatment of pain is frequently reported, especially among seniors, with chronic non-cancer pain most likely to be under-treated. Legislation regarding the prescribing/dispensing of opioid analgesics (including multiple prescription programs [MPP]) may impede access to needed analgesics.



To describe access and intensity of use of analgesics among older Manitobans by health region.



A cross-sectional study of non-Aboriginal non-institutionalized Manitoba residents over 65 years of age during April 1, 2002 to March 31, 2003 was conducted using the Pharmaceutical Claims data and the Cancer Registry from the province of Manitoba. Access to analgesics (users/1000/Yr) and intensity of use (using defined daily dose [DDD] methodology) were calculated for non-opioid analgesics, opioids, and multiple-prescription-program opioids [MPP-opioids]. Usage was categorized by age, gender, and stratified by cancer diagnosis. Age-sex standardized rates of prevalence and intensity are reported for the eleven health regions of Manitoba.



Thirty-four percent of older Manitobans accessed analgesics during the study period. Female gender, increasing age, and a cancer diagnosis were associated with greater access and intensity of use of all classes of analgesics. Age-sex standardized access and intensity measures revealed the highest overall analgesic use in the most rural / remote regions of the province. However, these same regions had the lowest use of opioids, and MPP-opioids among residents lacking a cancer diagnosis.



This population-based study of analgesic use suggests that there may be variations in use of opioids and other analgesics depending on an urban or rural residence. The impact of programs such as the MPP program requires further study to describe its impact on analgesic use.

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1. Crichton B, Green M. GP and patient perspectives on treatment with non-steroidal anti-inflammatory drugs for the treatment of pain in osteoarthritis. Current Medical Research & Opinion 2002;18(2):92-6.
2. Landi F, Onder G, Cesari M, et al. Pain management in frail, community-living elderly patients. Arch Intern Med 2001;161(22):2721-4.
3. Moulin DE, Clark AJ, Speechley M, MorleyForster PK. Chronic pain in Canada-- prevalence, treatment, impact and the role of opioid analgesia. [see comment]. Pain Research & Management 2002;7(4):179-84.
4. Dominick KL, Bosworth HB, Dudley TK, Waters SJ, Campbell LC, Keefe FJ. Patterns of opioid analgesic prescription among patients with osteoarthritis. J Pain & Palliat Care Pharmacother 2004;18(1):31-46.
5. Anon. Manitoba Prescribing Practices Program. http://wwwnapraca/pdfs/provinces/mb/Manitoba _Prescribing_Practices_Program_May2006pdf 2006.
6. Simoni-Wastila L, Ross-Degnan D, Mah C, et al. A retrospective data analysis of the impact of the New York triplicate prescription program on benzodiazepine use in medicaid patients with chronic psychiatric and neurologic disorders. Clin Ther 2004;26(2):322-36.
7. Hill CS, Jr. Government regulatory influences on opioid prescribing and their impact on the treatment of pain of nonmalignant origin. J Pain & Symptom Management 1996;11(5):287-98.
8. Weissman DE. Do drug regulations affect medical practice? J Pain & Symptom Management 1992;7(5):257-8.
9. Morley-Forster PK, Clark AJ, Speechley M, Moulin DE. Attitudes toward opioid use for chronic pain: a Canadian physician survey.[see comment]. Pain Research & Management 2003;8(4):189-94.
10. Anonymous. The management of persistent pain in older persons. J Am Geriatr Soc 2002;50:S205-S24.
11. Kalso E, Allan L, Dellemijn PLI, et al. Recommendations for using opioids in chronic non-cancer pain. [see comment]. European Journal of Pain 2003;7:381-6.
12. Kozyrskyj AL, Mustard CA. Validation of an electronic, population-based prescription database. Ann Pharmacother 1998;32(11):1152- 7.
13. Roos LL, Mustard C, Nichol JP, et al. Registries and administrative data: organization and accuracy. Med Care 1993;31(3):201-12.
14. Roos LL, Roos NP, Cageorge SM, Nichol JP. How good are the data? Reliability of one health care data bank. Med Care 1982;20(3):266-76.
15. Metge C, Black C, Peterson S, Kozyrskyj AL. The population's use of pharmaceuticals. Med Care 1999;37(6 Suppl):JS42-59.
16. Paulose-Ram R, Hirsch R, Dillon C, Losonczy K, Cooper M, Ostchega Y. Prescription and non-prescription analgesic use among the US adult population: results from the third National Health and Nutrition Examination Survey (NHANES III). Pharmacoepidemiol Drug Saf 2003;12(4):315-26.
17. Smalbrugge M, Jongenelis LK, Pot AM, Beekman AT, Eefsting JA. Pain among nursing home patients in the Netherlands: prevalence, course, clinical correlates, recognition and analgesic treatment--an observational cohort study. BMC Geriatr 2007;7:3.
18. Carmaciu C, Iliffe S, Kharicha K, et al. Health risk appraisal in older people 3: prevalence, impact, and context of pain and their implications for GPs. Br J Gen Pract 2007;57(541):630-5.
19. Landi F, Onder G, Cesari M, et al. Pain management in frail, community-living elderly patients. Arch Intern Med 2001;161(22):2721- 4.
20. Weiner DK, Rudy TE. Attitudinal barriers to effective treatment of persistent pain in nursing home residents. J Am Geriatr Soc 2002;50(12):2035-40.
21. Ersek M, Kraybill BM, Pen AD. Factors hindering patients' use of medications for cancer pain. Cancer Pract 1999;7(5):226-32.
22. Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med 2001;17(3):417-31.
23. Horgas AL. Pain management in elderly adults. J Infus Nurs 2003;26(3):161-5.
24. Hartikainen SA, Mantyselka PT, LouhivuoriLaako KA, Sulkava RO. Balancing pain and analgesic treatment in the home-dwelling elderly. Ann Pharmacother 2005; 39(1):11-6.
25. Dwyer JW, Lee GR, Coward RT. The health status, health services utilization, and support networks of the rural elderly: a decade review. J Rural Health 1990;6(4): 379-98.
26. Mainous AG, 3rd, Kohrs FP. A comparison of health status between rural and urban adults. J Community Health 1995;20(5):423-31.
27. Shur CL, Franco SJ. Access to health care. In: Ricketts T e, ed. Rural health in the United States. New York, NY: Oxford University Press; 1999:25-37.
28. Goins RT, Williams KA, Carter MW, Spencer M, Solovieva T. Perceived barriers to health care access among rural older adults: a qualitative study. J Rural Health 2005;21(3): 206-13.