| dc.description.abstract | Chronic pain disproportionately impacts elderly individuals. The most widely used treatment for geriatric pain is medication. Due to the opioid epidemic, providers are advised to prescribe non-opioids to individuals suffering from chronic pain, however, serious side effects of non-opioids used for chronic pain may not be captured in clinical trials. Pharmacoepidemiology studies can point out potential side effects in prescription drug use in vulnerable populations, including the elderly, who may not have been included in clinical trials due to concurrent health conditions and medication use. This dissertation is composed of two retrospective cohort studies that use a random 20% sample of Medicare data from 2014-2018 to compare the safety of duloxetine and gabapentin, non-opioids that are commonly prescribed to treat non-cancer chronic pain. The first research paper compares the risk of serious cardiovascular events—including acute myocardial infarction, stroke, and out-of-hospital mortality—among new users of duloxetine to new users of gabapentin. This aim concluded that duloxetine and gabapentin had a similar risk of cardiovascular events, though we observed a trend toward more out-of-hospital deaths in gabapentin users compared to duloxetine users that appeared unrelated to the other assessed cardiovascular outcomes. A recent warning by the U.S. Food and Drug Administration suggests that respiratory depression may occur among gabapentinoid users with respiratory risk factors, including the use of central nervous system depressants such as opioids. The second research paper assesses the risk of mortality following concomitant use of gabapentin and
opioids, specifically accounting for daily dose of opioids. The results of our second research paper contribute to the growing body of evidence that an interaction exists between opioids and gabapentin in terms of mortality, specifically that higher doses of opioids contribute to this interaction. These pharmacoepidemiologic studies address potential side effects of non-opioid medications widely prescribed in the elderly for the treatment of non-cancer chronic pain. | |
