Pain Treatments After Hip Fracture Among Older Nursing Home Residents.

This was an observational study, not a randomised trial, so it cannot show that opioids caused lower death or less functional decline. Residents without opioids were not necessarily taking other visible pain medicines; acetaminophen and NSAIDs were often unobservable in the claims. Residents who received skilled nursing facility care were excluded because opioid dispensing data were not available, limiting generalizability. The timing of analgesic use may be misclassified. Time before the first non-opioid pain medicine may have been counted incorrectly, and pain medicines were often used as needed rather than on a schedule. The study used two versions of nursing home assessment data, so some pain and other covariates could not be fully adjusted. Pain control itself was not measured as an outcome.

No funding source is stated. One author holds stock in PointRight, an information services company advising long-term care and post-acute care suppliers and insurers, and chairs quality or advisory committees for a nursing home chain and a post-acute care organization. Two authors receive royalties for UpToDate falls chapters; one also received a book honorarium. Other authors reported no relevant conflicts.

Do not conclude that opioids reduce death after hip fracture. The study is observational, the non-opioid group may have included people taking acetaminophen or NSAIDs not visible in claims, pain relief was not measured, and the authors say risk of bias remains high.