Using opioid analgesia for chronic pain in adults aged 85+: a qualitative study

  1. Alice Faux-Nightingale
  2. Charlotte Woodcock
  3. Christine Walker
  4. Helen E Smith
  5. Victoria K Welsh
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Abstract

Background

Chronic pain is common in adults aged 85 years and older (85+) and is associated with detrimental outcomes. Chronic pain guidelines advise first line management with non-pharmacological measures; paracetamol and non-steroidal anti-inflammatory drugs are the preferred analgesics. Challenges in accessing non-pharmacological therapies for adults aged 85+, and the presence of multimorbidity and polypharmacy, mean that opioid medication is often prescribed for chronic pain despite the potential for opioid-related adverse effects and guidance identifying long-term opioids for chronic pain as a potentially inappropriate prescription.

Aim

This study aims to explore patient, caregiver, and healthcare professional perspectives on the prescription of opioid medications for pain management for chronic pain in adults aged 85+ to support development of resources for optimising opioid prescribing.

Design and Setting

In this qualitative study, participants were recruited through primary care, in the community or in care home settings.

Method

36 semi-structured interviews were conducted with care home residents and community dwellers aged 85+ (n=12), caregivers (informal and care home staff) (n=12), and healthcare professionals (n=12). Interviews were transcribed and analysed using reflexive thematic analysis.

Results

Four themes were developed: contextual complexity, satellite influences, balancing act, and pragmatic prescribing. Using opioids in adults aged 85+ is a balancing act to support patients’ best possible quality of life within their unique circumstances whilst using the pain management tools available.

Conclusion

Opioids continue to have an important role in pain management in adults aged 85+ largely due to paucity of alternatives and the drive to support quality of life.

Key points

  • Managing chronic pain in adults aged 85+ is complex; a pragmatic approach to opioids is adopted by patients, caregivers, and prescribers;

  • A focus on improved access to non-pharmacological therapies may offer alternatives to opioids;

  • Emerging Integrated Neighbourhood Teams in England presents a valuable opportunity to support chronic pain for adults aged 85+.

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    1. Version published to 10.64898/2026.06.08.26354706 on medRxiv