Association of Risk Factors and Comorbidities With Chronic Pain in the Elderly Population

INTRODUCTION/OBJECTIVE

Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors. The aim of this study was to investigate the comorbid medical conditions and risk factors associated with chronic pain disorders in patients aged 65 years and older.

METHODS

Our team retrospectively reviewed medical records of elderly patients (65 years and older) who were evaluated in our outpatient medicine office between July 1, 2020 and June 30, 2021 for acute problems, management of chronic medical problems, or well visits. We divided our patients into a group who suffered from chronic pain disorder, and another group who did not have chronic pain disorder. The association of variables were compared between those groups.

RESULTS

Of the 2431 patients, 493 (20.3%) had a chronic pain disorder. A higher frequency of females in the group with chronic pain disorder was found compared to the group without a chronic pain disorder (60.6% vs 55.2%; P = .033). The mean ages between the two groups were similar in the group with a chronic pain disorder compared to the group without (76.35 ± 7.5 year vs 76.81 ± 7.59 year; P = .228). There were significant associations of certain comorbidities in the group with a chronic pain disorder compared to the group without a chronic pain disorder, such as depression (21.9% vs 15.2%; P < .001), anxiety (27.0% vs 17.1%; P < .001), chronic obstructive pulmonary disease (8.7% vs 6.1%; P = .036), obstructive sleep apnea (16.8% vs 11.6%; P = .002), gastroesophageal reflux disease (40.8% vs 29.0%; P < .001), osteoarthritis (49.3% vs 26.1%; P < .001), other rheumatologic diseases (24.9% vs 19.4%; P = .006), and peripheral neuropathy (14.4% vs 5.3%; P < .001).

CONCLUSION

Female sex, depression, anxiety, chronic obstructive pulmonary disease, obstructive sleep apnea, gastroesophageal reflux disease, osteoarthritis, other rheumatologic diseases, and peripheral neuropathy were significantly associated with chronic pain disorder in elderly patients, while BMI was not associated with chronic pain disorder.

Expanding Medical Student Knowledge and Impacting Patient Outcomes Through a Student-Run Clinic: A Case-Based Reflection

Cryptogenic stroke is a debilitating condition that requires follow-up care and treatment that is appropriate for the underlying etiology. Here, we present the case of a 46-year-old uninsured patient with an undocumented immigration status who presented to our student-run clinic (SRC) for the management of her post-stroke care. She initially presented to an outside hospital with focal neurological deficits, was diagnosed with an acute stroke, and was told to follow up with a primary care provider. The patient established care at the Cooper Medical School of Rowan University's SRC one week following her stroke event. The SRC served as a conduit for access to healthcare services necessary for her recovery and secondary prevention of future strokes which otherwise would have been unattainable due to the patient's socioeconomic constraints. These services and treatments included specialist appointments, anticoagulation medications, physical and speech therapy, labs, placement of an internal heart rhythm monitor, and surgical closure of a patent foramen ovale. All services, medications, and procedures were provided free of charge. One year following her stroke, the patient is living without disability and has had no recurrence of a cerebrovascular ischemic event. This case highlights the dual-purposed value of SRCs in providing both meaningful clinical educational experiences to students and necessary health care to disadvantaged patients.

Comorbidities and Risk Factors Associated With Insomnia in the Elderly Population

INTRODUCTION/OBJECTIVES

Sleep disorders affect around 50 to 70 million Americans, with chronic insomnia being the most common, especially in the elderly population. With an 11-fold increase in the US office visits due to insomnia, from 0.8 to 9.4 million, between 1993 and 2015, it is imperative to identify the modifiable risk factors. The aim of our study was to examine the association of risk factors and comorbid medical conditions with insomnia in patients 65 years, and older.

METHODS

We performed a retrospective electronic medical record review of the patients aged 65 years and older, who visited our suburban internal medicine office between July 1, 2020 and June 30, 2021. Patients were divided into insomnia group, and the group without insomnia. The associated variables were compared.

RESULTS

Among 2431 patients, 247 patients (10.2%) had insomnia. Mean ages of the patients in the insomnia group and the group without insomnia were comparable (77 ± 8.1 year vs 76 ± 7.5 year; P = .211). There was a significantly greater frequency of women in the insomnia group compared to the group without insomnia (63.2% vs 55.5%; P = .022). In the insomnia group, there were significantly higher frequencies of association of certain comorbidities compared to the group without insomnia, such as dementia (6.5% vs 3.4%; P = .015), depression (30.8% vs 14.9%; P < 0.001), anxiety disorder (34.4% vs 17.4%; P < .001), atrial fibrillation (19.4% vs 13.4%; P = .01), and chronic pain disorders (32.8% vs 18.9%; P < .001). Logistic regression analysis showed significantly greater odds of insomnia in patients who had depression (OR = 1.860, 95% CI 1.342-2.576; P < .001), anxiety (OR = 1.845, 95% CI 1.342-2.537; P < .001), and chronic pain disorders (OR = 1.901, 95% CI 1.417-2.549; P < .001).

CONCLUSIONS

Female sex, dementia, depression, anxiety, chronic pain disorders, and atrial fibrillation are associated with insomnia in the elderly patients. Presence of depression, anxiety, and chronic pain disorders are associated with greater odds of having insomnia in the elderly patients.

Efficacy of Split Schedule Versus Conventional Schedule Neoadjuvant Cisplatin-Based Chemotherapy for Muscle-Invasive Bladder Cancer

Neoadjuvant cisplatin-based chemotherapy (NAC; 70 mg/m2) is standard of care for muscle-invasive bladder carcinoma (MIBC). Many patients (pts) cannot receive cisplatin because of renal impairment, and administration of cisplatin 35 mg/m2 on day 1 + 8 or 1 + 2 (i.e., split schedule) is a commonly used alternative. In this retrospective analysis, we compared complete (pT0) and partial ( Collapse

Key Words

• Cisplatin
• Muscle‐invasive bladder cancer
• Neoadjuvant chemotherapy
• Nephrotoxicity

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MESH Headings

• Aged
• Antineoplastic Combined Chemotherapy Protocols/administration & dosage
• Antineoplastic Combined Chemotherapy Protocols/adverse effects
• Carcinoma, Transitional Cell/pathology
• Carcinoma, Transitional Cell/therapy
• Cisplatin/administration & dosage
• Cisplatin/adverse effects
• Cystectomy
• Female
• Humans
• Kidney/drug effects
• Male
• Neoadjuvant Therapy/adverse effects
• Neoadjuvant Therapy/methods
• Neoplasm Invasiveness/pathology
• Neoplasm Staging
• Renal Insufficiency/chemically induced
• Renal Insufficiency/epidemiology
• Renal Insufficiency/prevention & control
• Retrospective Studies
• Treatment Outcome
• Urinary Bladder Neoplasms/pathology
• Urinary Bladder Neoplasms/therapy

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Grants

• K23 CA187185 NCI NIH HHS

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Affiliation(s)

Chelsea K Osterman University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
Dilip S Babu University of Rochester Medical Center, Rochester, New York, USA
Daniel M Geynisman Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
Bianca Lewis Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
Robert A Somer MD Anderson Cancer Center at Cooper, Camden, New Jersey, USA
Arjun V Balar Langone Medical Center, New York University, New York City, New York, USA
Matthew R Zibelman Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
Elizabeth A Guancial Florida Cancer Specialists and Research Institute, Sarasota, Florida, USA
Gianna Antinori MD Anderson Cancer Center at Cooper, Camden, New Jersey, USA
Shun Yu Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Vivek Narayan Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Thomas J Guzzo Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Elizabeth R Plimack Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
David J Vaughn Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Chunkit Fung University of Rochester Medical Center, Rochester, New York, USA
Ronac Mamtani Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA

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