The Influence of Socioeconomic Factors on the Use of Pain Medication

Medication is a key strategy to mitigate pain, yet it is less accessible to those with fewer resources

(October 2020) The experience of pain is widespread among older adults and has substantial functional consequences, including falls, increased burden on others, and lower quality of life. It also inflicts high costs on both individuals and society. Given the widespread experience of pain among middle-aged and older adults, the importance of medication in pain management, and the inequalities in taking pain medication that middle-aged and older adults may face, it is important to examine the characteristics that influence pain medication use. Therefore, researchers Shuldiner, Tur-Sinai, and Bentur investigated the characteristics associated with using pain medication among middle-aged and older adults in 15 European countries and Israel.

SHARE data reveal prevalence of musculoskeletal pain and management strategies

Drawing on data from Wave 5 of the Survey of Health, Ageing and Retirement in Europe (SHARE), the researchers identified factors associated with the presence of musculoskeletal pain and pain medication use. In this sample of over 64,000 respondents from Europe and Israel the prevalence of musculoskeletal pain (aching back, hips, knees, and other joints) was 40.1%. Among those who reported musculoskeletal pain, 21.5% reported mild pain, 52.9% moderate, and 26% severe. The share of musculoskeletal pain was higher among women, those who lived alone, and those who were not employed. The average age among those who reported musculoskeletal pain was 67.4 years.

Diverse strategies exist for the management of pain, such as physiotherapy and complementary therapies including acupuncture, transcutaneous electrical nerve stimulation, biofeedback training, relaxation, and massage. However, the most commonly used strategy is medication. Surveys demonstrate that pain management among middle-aged and older adults is insufficient, due to a variety of factors: patients receive inadequate pain management, including no prescription medication to manage it even though they are consistently in pain.

Access to pain medication is dependent on socioeconomic status

About half of those who reported musculoskeletal pain took no medication to manage it. The odds of not using medication were higher among men and those who were older, less educated, and less able to cope economically. These results suggest that pain medication may be less accessible to those with fewer resources. Financial hardship is a significant barrier to pain medication use which could be addressed in the form of coinsurance, fixed prescription charges, deductibles or reimbursements instead of out-of-pocket costs of medications as it is possible that higher copayment on medications more strongly affects results. It has been established that even modest levels of cost-sharing can lead patients to forgo the use of medication. The association between the ability to cope economically and pain medication use is particularly significant as the consequences of cost-related underuse of medication include increased visits to emergency departments, psychiatric admissions, nursing home admissions, and lower quality of life.

Implications for pain management strategies

Pain is a significant public health problem that has effects such as decreased physical functioning and quality of life among middle-aged and older adults. Given their extensive role in primary care, nurses should be aware of the association between education and income with pain medication use that suggests that medication is less accessible to those with fewer resources. Medication is a key musculoskeletal pain management strategy. Hence, access to medicine deserves attention from nurses, healthcare workers and policymakers.

Study by Jennifer Shuldiner, Aviad Tur-Sinai and Netta Bentur (2019): Musculoskeletal Pain Medication Use in Middle Age and Older Adults in 15 European Countries and Israel. Pain Management Nursing 21, 165-171.


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