Controlled Drug Use and Falls in Older People With Neurogenic Claudication: Secondary Analysis of the BOOST RCT

BACKGROUND: Controlled pain medications increase the risk of falls. Despite this, they are commonly prescribed for painful neurogenic claudication. Previously, we reported that the Better Outcomes for Older People with Spinal Trouble (BOOST) program improved walking and reduced overall falls at 12 months. The aim of this study was to determine whether, in comparison to best practice advice, a physical and psychological group intervention (PPGI) changed pain medication use and to determine the mechanisms of fall reduction. METHODS: Secondary and mediation analysis of the BOOST randomized controlled trial. There were 435 people enrolled at baseline. Follow-up was at 6 and 12 months after randomization. At baseline and follow-up, we classified participants into three groups: (1) not using any pain medication; (2) using only non-controlled medication; and (3) using at least one controlled pain medication, with or without other pain medications. Physical performance tests, patient-reported outcomes, medication use, and falls were collected at all time points. RESULTS: At baseline, 63% (n = 274/435) of participants reported taking at least one pain medication, with 34% (n = 149/435) taking at least one controlled medication. At 6 months, the PPGI was more effective than best practice in reducing the use of controlled medications [OR 0.62, 95% CI (0.40, 0.96)] although these differences narrowed by 12 months. There was a modest treatment benefit in pain. Several factors mediated falls prevention at 12 months, notably a reduction in controlled pain medication in the first 6 months of follow-up. CONCLUSIONS: PPGI reduced controlled pain drug use at 6-months, and this contributed to reduced falls by 12-months. Intervention refinements may improve the effect on controlled medication reduction. TRIAL REGISTRATION: ISRCTN 12698674.