PINTO-85 1.0
Research type
Research Study
Full title
EXPERIENCES OF MANAGING PAIN WITH OPIOID MEDICATIONS IN ADULTS AGED 85 YEARS AND OLDER
IRAS ID
325226
Contact name
Victoria Welsh
Contact email
Sponsor organisation
Keele University
Clinicaltrials.gov Identifier
NIHR number, 644; PID, PID-220365
Duration of Study in the UK
0 years, 8 months, 31 days
Research summary
Summary of Research
Chronic or persistent pain is pain that has lasted more than 3 months. In the oldest old, those aged 85 years and older, persistent pain is common and often difficult to manage. Guidelines recommend approaches to pain management that do not involve medication (e.g., exercise). However, healthcare professionals (HCPs) continue to prescribe painkillers, such as opioids, despite associated adverse side effects and limited scientific evidence to support their long-term effectiveness.
HCPs need support to move away from prescribing opioids in the oldest old. To better support HCPs, we need to understand the values and beliefs of patients, their families and HCPs towards prescribing opioid medication. Only then can we start to develop support for HCPs to move towards recommending alternative pain management approaches.This study will interview patients (i.e., people living with persistent pain who are prescribed opioids), a close family member or carer, and prescribing HCPs to understand:
1. The attitudes and beliefs of the oldest old who are living with pain towards the use of opioids to manage persistent pain;
2. The attitudes and beliefs of carers and family members towards the use of opioids to manage the persistent pain of their client or family member;
3. The attitudes and beliefs of health care professionals towards the use of opioids to manage persistent pain in their oldest old populations.Study participants will be recruited from the West Midlands area and, where possible, we will seek to interview patient-carer-HCP ‘triads’ where the family member or carer and HCP are directly involved with the care of the patient. The study will be conducted from March 2023 for 12 months. During this time, interviews will be conducted individually demanding a time commitment from each participant of one hour.
Summary of Results
• What is the study title?
Experiences of managing pain with opioid medications in adults aged 85 years and older (PINTO-85)• Who carried out the research?
This research was carried out by researchers at Keele University. This study was funded by the National Institute for Health Research School (NIHR) for Primary Care Research. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.• What public involvement there was in the study?
Members of the public were part of the project from the beginning. We had a PINTO-85 public involvement group who helped us to define our research question, find ways to invite people to take part in our study, design our study invitations and information sheets, and produce the material that shares our research findings.We also had a member of the public join our research team who was able to bring her lived experiences to our research.
• Where and when did the study take place?
PINTO-85 took place April 2023 and April 2025. Interviews were carried out between January and April 2024. We invited staff working at general practices and care homes, residents living in care homes, and residents living in the community with their caregivers. We recruited from the West Midlands, Berkshire, and East London. From April 2024-April 2025, we analysed our interview data, met with our public groups and our stakeholder group, and developed our materials to share our key messages with the public, healthcare professionals, and researchers.• Why was the research needed?
Pain is common in people aged 85 or over (called the ‘oldest old’) and can be difficult to manage in this age group. Currently clinical guidelines recommend non-drug options to help manage pain, like exercise, physiotherapy, or psychological therapies. The use of pain-killing medication, particularly strong painkillers like opioid medications (which include medicines that contain codeine, tramadol, or morphine) is not encouraged. However, the non-drug options can be difficult for the oldest old to try. We know that doctors prescribe opioid medication to this age group, but these medicines can have side effects which affect daily activities and could lead to falls, confusion and hospital admission.Currently, research has only investigated the experiences of people who are younger than 85, and nothing is known about people in this older age group who are not receiving end-of-life care. This research in younger people has suggested that opioid medication can be “a salvation and a curse”, and there are lots of things which can affect people's choices to take medication, like side effects, stress, and opinions of people around them. Research also suggests that there can sometimes be unintentional communication difficulties between patients and doctors when talking about pain management options. Before we can start trying to reduce the prescribing of opioid medications to the oldest old, we must first understand the views of those who choose to take them for pain and their caregivers, and the healthcare professionals who prescribe opioid medications.
• What were the main questions studied?
-What do older adults living with pain, the people who care for them, and healthcare professionals think about opioid medications?
-How do these three groups (older adults living with pain, people who care for them, and healthcare professionals) work together to support older people with pain?
-What makes a good consultation between healthcare professionals and patients, when talking about pain?
-Are there any challenges around opioid medications which may have led to dissatisfaction or risk-taking?
-Is support needed for oldest old adults living with pain, their significant other, and HCPs, to facilitate conversations around the use of opioid medication for persistent non-palliative pain? If so, what would this look like?• Who participated in the study?
Our study interviewed 36 people. This included 12 people aged 85 years and older (ranging from aged 85 to aged 101), 3 family caregivers, 10 care home staff, and 12 healthcare professionals including general practitioners (GPs) and pharmacists. Our study participants were from a mix of Ethnic backgrounds, although all of our patients identified as white British.• What happened during the study?
Participants took part in one interview with a member of the research team where they talked about their experiences with opioid medications and their thoughts about prescribing opioid medications to people aged over 85.• What were the results of the study?
We found that the decision to prescribe opioid medication, or to take these medications for chronic pain, was a complex process. We identified three themes in our interviews. One theme covered the impact of opioids beyond pain relief (for example, taking the medication to help other symptoms, or avoiding it due to side effects). Another theme covered the practical, or ‘pragmatic’ approach to deciding to prescribe or take opioids for chronic pain. A third theme covered the need to balance the risks and benefits of prescribing or taking opioids for chronic pain, considering the individual and unique circumstances surrounding each decision.During our interviews, we also found that people in the community, and their caregivers, sometimes feel that they need extra support beyond the advice they received during their consultation with a healthcare professional. For example, more information on how to take the medication, and how to communicate their symptoms of pain. We found that the residents of the care homes we included in our study were able to access support and advice from healthcare professionals faster than those people living in the community.
• How has this study helped patients and researchers?
PINTO-85 has produced a resource for patients and their caregivers in the community to help prepare for a consultation with their healthcare professional about pain including support to communicate their experiences of pain and its impact on their daily life, and a section to help with understanding the medication. Our results will help to inform future guidance for healthcare professionals to help manage chronic pain in our oldest old population.We have identified aspects of pain management in the oldest old that require further research, for example, how to best support the information needs for this population and their caregivers.
• Details of any further research planned
We are planning to look at the role of genetic testing to further help to optimise prescribing of opioid medications for care home residents. We would also like to plan further research that aims to best support our oldest old community residents and caregivers in managing chronic pain.REC name
West of Scotland REC 3
REC reference
23/WS/0118
Date of REC Opinion
4 Aug 2023
REC opinion
Favourable Opinion