Chronic pain among community-dwelling elderly: a population-based clinical study

Abstract

ObjectiveTo present the occurrence, characteristics, etiology, interference, and medication of chronic pain among the elderly living independently at home.Design/settingA total of 460 subjects in three cohorts aged 75, 80 and 85 years respectively received visits by communal home-care department nurses for a cross-sectional survey. Of them, 175 had chronic (duration ≥ 3 months) pain with an average intensity of ≥ 4/10 and/or ≥ moderate interference in daily life.Main outcome measuresClinical assessment was performed for consenting subjects to define the location, intensity, etiology, type, interference and medications of chronic pain.ResultsAccording to home visits, elderly people with chronic pain rated their health and mobility worse and felt sadder, lonelier and more tired than those without chronic pain. A geriatrician made clinical assessments for 106 patients with chronic pain in 2009–2013. Of them, 66 had three, 35 had two and 5 had one pain condition. The worst pain was musculoskeletal in 88 (83%) of patients. Pain was pure nociceptive in 61 (58%), pure neuropathic in 9 (8%), combined nociceptive and neuropathic pain in 34 (32%), and idiopathic in 2 (2%) patients. On a numerical rating scale from 0 to 10, the mean and maximal intensity of the worst pain was 5.7 and 7.7, respectively, while the mean pain interference was 5.9. Mean pain intensity and maximal pain intensity decreased by age. Duration of pain was longer than 5 years in 51 (48%) patients. Regular pain medication was used by 82 (77%) patients, most commonly paracetamol or NSAIDs. Although pain limited the lives of the elderly with chronic pain, they were as satisfied with their lives as those without chronic pain.ConclusionsElderly people in our study often suffered from chronic pain, mostly musculoskeletal pain, and the origin of pain was neuropathic in up to 40% of these cases. However, elderly people with chronic pain rarely used the medications specifically for neuropathic pain. Based on increased loneliness, sadness and tiredness, as well as decreased subjective health and mobility, the quality of life was decreased among those with chronic pain compared with those without pain. KEY POINTSIt is known that chronic pain is one of the most common reasons for general practice consultations and is more common in women than men.In our study using detailed clinical examinations, up to 40% of patients with chronic pain in cohorts aged 75, 80 and 85 years suffered from neuropathic pain.However, only a few elderly people with chronic pain used medications specifically for chronic pain, which may be due to side effects or non-willingness to experiment with these drugs.Elderly people with chronic pain rated their health and mobility to be worse and felt sadder, lonelier and more tired but were not less satisfied with their lives than those without chronic pain.

Associação de dor crônica com força, níveis de estresse, sono e qualidade de vida em mulheres acima de 50 anos

“…However, when there is a decrease in the self-perception of strength, there is a reduction in the pain threshold, which can be exacerbated by psychological factors. It is noteworthy that studies show that this sensitivity occurs in parallel to the reduction in muscle strength 1,3,24 ; however, in this study, it was not possible to observe such behavior in the study sample.…”

“…Several Brazilian studies show that middle-aged individuals (40 to 59 years) and those over 60 years present a higher prevalence of chronic pain (varying between 51 and 67%), mainly musculoskeletal pain (14 to 47%) [1][2][3] . Chronic pain is the main cause of complaints in hospitals and outpatient clinics and a frequent symptom in anamnesis for older adults 4,5 .…”

“…Approximately 45% to 80% of the older adults institutionalized suffer at least one type of pain, being 61% prevalent for middle-aged individuals, especially women. Moreover, it is estimated that 80 to 85% of individuals over 65 years of age present at least one significant health problem that predisposes them to report pain [3][4][5][6] .…”

Effects of the Characteristics and Duration of Chronic Pain on Psychosomatic Function in the Community-Dwelling Elderly Population

“…In Japan, rapid aging of the population has increased the number of community-dwelling elderly people who require long-term care due to decline in psychosomatic functions [6,7]. Previous studies have shown that CP is associated with increased isolation and fatigue and decreased subjective health, ADL, and motor functions in communitydwelling elderly people [8][9][10].…”

Chronic pain with use of analgesics and mortality in the home healthcare elderly: a nationwide population-based study

“…Chronic pain in the elderly is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage, for persons who are age  65 years with pain for greater than 3 months" [7]. Chronic pain may cause many complications in the elderly, including impaired activities of daily living, depression, deconditioning, polypharmacy, cognitive decline, poor quality of life, increased care burden and medical expenditure, and increased mortality [7][8][9]. Understanding the causes of chronic pain, its comorbidities, the use of medical or nursing resources, analgesic use, and subsequent mortality is crucial.…”