HOPE-AO: Helping to Optimise Pain control in the Elderly experiencing Analgesic Overprescribing

Background Chronic pain is estimated to affect over 40% of community dwelling older adults. Pain medication prescribing is highest in older adults, with substantial increases in recent decades, yet this population remains under-researched. Long-term pain medication usage has several side effects and limited positive impact for many people. This 18-month development grant will address these issues and provide the foundation for a full programme grant, to co-design a safer prescribing framework and guide older adults towards alternative solutions to pain medication. Components for this framework will be identified according to the preferred approaches identified by the older adults themselves to be further developed and tested in the future programme. Development Work Investigate prescribing patterns and relationships for chronic pain in older adults, in the context of clinical and sociodemographic factors, to identify which patients are most likely to benefit from targeted interventions, as well as shaping potential intervention strategies (Work Package 1 - WP1). Investigate experiences of older adults, caregivers and health care professionals (prescribers) along with identification of safer prescribing and pain management solutions, whilst engaging with potential co-design participants for a future programme grant (WP2). Aims/objectives The project has two key aims (WPs) to understand more about: 1) the population most likely to benefit from alternative pain management solutions; 2) their experiences and expectations about pain prescribing and management. The findings from both WPs will then be synthesised, allowing us to identify potential solutions or interventions for future codesign and evaluation. Workplan and timelines WP1 (0-15 months) will comprise a quantitative analysis of the Clinical Practice Research Datalink (CPRD), focusing on adults aged 65+ in England who are prescribed medication for chronic pain, from at least one of: opioids, NSAIDs, paracetamol, low dose tricyclics, and gabapentinoids. We will explore patterns of pain prescribing, changes over time, factors associated with prescribing, and potential health outcomes. This will provide us with an understanding of the population most likely to benefit from targeted interventions, and which aspects of care they might address. WP2 (0-15 months) will include interviews of older adults prescribed pain medication, their family carers, and healthcare professionals. The interviews will cover experiences of pain medication prescribing, pain symptoms, and wider healthcare system experiences. They will also explore views on the effectiveness of prescribed medication, understanding of how these drugs work, benefits, risks, and potential side effects. Additionally, the readiness to engage with alternative co-designed pain solutions will be explored. This 18-month project will conclude with the syntheses of work packages (12-18 months) and preparation for the future programme of work. Anticipated Impact & Dissemination We anticipate one publication and conference presentations from each WP. This initial study may impact policies. For example, the Scottish Intercollegiate Guidelines Network (SIGN) is keen to address the issue of deprescribing in their guidance. The National Guidelines for the management of pain, recommend caution in prescribing any analgesics for long periods in older adults and this study may influence implementation of these guidelines.