The HOPE-AO project (Helping Older People Engage with Analgesia Optimisation) examines whether certain groups of the older population are prone to overprescribing and any side effects or other harms these medications can pose if taken for long periods. It also aims to identify alternative treatment solutions to reduce the use of unnecessary analgesic pain medicines, working with patients to develop a list of acceptable strategies that could be tested and implemented across the UK.
Around four million older people in the UK live with chronic pain caused by conditions such as arthritis, diabetes, or frailty. While pain relief medications like paracetamol, ibuprofen, opioids, and antidepressants can be effective for some, many individuals are prescribed these medicines on a long-term, repeat basis – sometimes for months or even years – without sufficient review or follow-up.
Led by PenARC researchers at the University of Plymouth, the study involves a collaborative team from the University of Exeter, Aston University, University of Aberdeen, and the North East London Foundation NHS Trust, and is funded by a Programme Development Grant from the National Institute for Health and Care Research (NIHR).
The research team includes experts in healthcare for older adults, including nurses, GPs, pharmacists, consultants, psychiatrists, statisticians, and health economists, alongside an advisory group of older people with lived experience of chronic pain and long-term medication use.
As part of the study, the team will speak to people aged 65 and over who have experienced chronic pain and been prescribed pain medication, as well as family members who support them. Healthcare professionals involved in prescribing and managing pain will also be consulted.
In parallel, the researchers will carry out a statistical analysis of anonymised healthcare data to better understand patterns of prescribing, associated health and demographic factors, and outcomes for older adults living with pain.
Professor Patricia Schofield, Professor of Clinical Nursing at the University of Plymouth and one of the study’s Chief Investigators, said:
“Very often, older people are told by a doctor that the most effective means of treating a health condition is through some form of pain relief. But they often don’t get any form of follow-up appointment and, as a generation, are less likely to seek one as they either feel pain is part of the ageing process or they don’t wish to be seen as a burden. The result is that they end up getting repeat prescriptions, potentially for pain medications they no longer need and also at a significant cost to the NHS. This study will give us a clearer understanding of the scale of the issue, which we can use to develop ways of benefiting patients and their families, and the healthcare professionals working to treat and support them.”
Dr Stuart Spicer, Senior Research Fellow at PenARC and the study’s other Chief Investigator, added:
“This is a crucial healthcare issue affecting older adults. High levels of pain medication prescribing have generated widespread concern and controversy, and pose a pressing global health challenge.
Older adults are prescribed pain medication, such as opioids, more than any other age group, yet the complexities surrounding prescribing and overprescribing in this population remain poorly understood. Many older adults could benefit from a reduction in prescribed pain medication, alongside greater access to non-drug approaches for managing chronic pain.
This project will enable us to develop a deeper understanding of these issues, while providing a greater voice to older adults living with chronic pain. In the future, this work will contribute to the development of safer and more effective pain management practices.”
Rajinder Flora, Assistant Director of NIHR Programme Grants for Applied Research, commented:
“We are pleased to fund this important project investigating the impact of overprescribing in older adults living with chronic pain. We’re proud to support research that brings together a range of expertise to improve care and help to save money for the NHS.”
Patients and Public Involvement and Engagement (PPIE) Group at the Centre of the Research
Patient and public involvement is central to HOPE-AO. The study’s PPIE group is chaired by Victoria Abbott-Fleming MBE, founder of the charity Burning Nights CRPS Support. Victoria has lived with chronic pain for over 20 years due to Complex Regional Pain Syndrome (CRPS) and is a well-known advocate for patient voices in pain management.
Victoria said:
“I’m excited to support this study that places the voices of older adults and their carers at the heart of pain management. All too often, those living with chronic pain – especially older adults – are prescribed medication without regular review or consideration of alternative approaches.
This study is a vital step towards more informed and balanced care, helping ensure that older people living with chronic pain are not just treated, but truly heard and supported.”
Authors
Dr Stuart Spicer
Senior Research Fellow