The following is a summary of “Central nervous system active medication use in Medicare enrollees receiving home health care: association with chronic pain and anxiety level,” published in the July 2024 issue of Pain by Raji et al. 

Comparative effectiveness data for nonopioid analgesics and nonbenzodiazepine anxiolytics in treating pain with anxiety is lacking.

Researchers conducted a retrospective study investigating how different medications and multiple medications affecting the central nervous system (CNS) relate to pain and anxiety in patients enrolled in Medicare receiving home healthcare (HH).

They examined data on patients enrolled in Medicare receiving HH diagnosed with certain conditions, including patients who had pain and anxiety assessed at least twice during the care. The analysis revealed how many medications, specific drug types, and combinations of drugs affected daily pain and anxiety reduction using linear regression. The number and type of drugs impacted were also assessed, achieving low pain or anxiety levels at discharge by logistic regression. Finally, multinomial regression evaluated the practical importance of the findings by observing a substantial improvement in pain and anxiety.

The result showed 85,403 patients on HH, 43% were on opioids, 27% on benzodiazepines, 26% on gabapentinoids, 32% on SSRIs, and 8% on serotonin and norepinephrine reuptake inhibitors (SNRI). Additionally, 75% had depression, 40% had substance use disorders, and 6.9% had PTSD. At HH admission, 83% experienced daily pain, 35% had daily anxiety, and 30% reported both. The CNS polypharmacy was linked with worse pain control and did not significantly impact anxiety. Patients with both daily pain and anxiety benefited most from a single medication or any combination, excluding opioids/benzodiazepines. Gabapentinoids or SNRIs effectively managed pain, while SSRIs significantly increased anxiety.

Investigators concluded that CNS polypharmacy may worsen pain control in patients on HH, and careful consideration of medication combinations was crucial for managing pain and anxiety.

Source: journals.lww.com/pain/abstract/9900/central_nervous_system_active_medication_use_in.651.aspx