Centralized Pain Diagnoses in Older Adults With and Without Cancer

Chronic pain is highly prevalent in older adult cancer survivors, but the prevalence of nociplastic pain is ill-defined. This is important because nociplastic pain responds poorly to opioids, the cornerstone of cancer pain management. Moreover, older adults face high risk of respiratory depression, falls, and mortality from opioids. Given these risks, a better understanding of nociplastic pain prevalence is needed. This was a cross-sectional analysis study at a large, academic medical center. Patients ≥65 years of age with at least one outpatient visit between November 1, 2015 and December 23, 2021 were included. The primary outcome was the proportion of older adults, with and without cancer, with a chronic overlapping pain condition (COPC) diagnosis (a type of nociplastic pain). There were 320,727 older adults included and 15.5% carried at least one COPC diagnosis. Those with COPCs were more likely to be female, younger, and have a higher Elixhauser Comorbidity Index. Black Americans were less likely to carry a COPC diagnosis. The incidence rate of COPCs was 1.0333 times higher in older adults with cancer (95% CI [1.014, 1.053], p = 0.001). One in six older adults had a COPC diagnosis. Those with cancer were more likely to carry a COPC diagnosis than their peers without.