<p>Association Between Multimorbid Disease Patterns and Pain Outcomes Among a Complex Chronic Care Population in Canada</p>

Abstract

Purpose: Disease multimorbidity and pain is a complex, yet common, problem for the aging population, and a significant burden on the health-care systems around the world. Despite this, disease comorbidity and the association with pain in a complex chronic care population is not well understood. This study examined the most prevalent disease combinations and their association with pain. Patients and Methods: The study initially included 139,920 residents, aged 18-101 years, admitted to publicly funded hospital facilities for complex chronic care in Canada between the years 2006 and 2016. Data were acquired through the Canadian Institute for Health Information (CIHI) Facility-Based Continuing Care Reporting System (CCRS). Descriptive and chi-square statistics were used to summarize and compare the sample characteristics. Binary logistic regression analyses were used to examine the association between multimorbid disease categories and pain outcomes. Results: The sample consisted of 139,573 residents (57% female), mostly older (mean age = 77.32 years), married (40%), or widowed (36%). Residents took an average of 11.9 medications and 77% were using analgesic medications. On average, residents had diagnoses from 3.06 disease categories (SD = 1.43). Heart/circulation diseases were the most prevalent among the sample (73%), with neurological second (46%) and musculoskeletal third (44%). Overall, 73% of residents reported pain, with 43% reporting moderate pain severity. Residents with multiple disease categories were more likely to report the presence of pain (OR = 1.08, 95% CI: 1.07-1.08, p < 0.001), with each additional disease category associated with an 8% increase in the odds of reporting pain. Conclusion: The findings from this study help identify common comorbid disease patterns related to pain in an institutionalized, complex chronic care population. This information contributes to both the pain and multimorbidity literature, and is invaluable for creating care plans to meet the demands of a challenging population.

Multimorbidity Is Associated With Pain Over 6 Years Among Community-Dwelling Mexican Americans Aged 80 and Older

“…Our findings are consistent with previous work that found a link between pain and multimorbidity ( 21 , 23 – 25 , 27 ). For example, a study of multimorbidity and pain among adults aged 18 and older in Canada found that both pain and multimorbidity were common, and the odds of reporting pain increased with both multimorbidity and the number of multimorbid conditions ( 25 ). This latter finding was also observed in New Zealand among adults aged 15 and older, where those with multimorbidity had higher odds of reporting chronic pain ( 21 ).…”

“…A literature review of 52 studies estimated that the prevalence of multimorbidity among older adults (65 and older) in high-income countries was 66.1% ( 20 ). Pain is prevalent among older adults with multimorbidity ( 6 , 21 – 25 ). This is concerning, as chronic pain and multimorbidity have shared risk factors, such as age, gender, frailty, and physical inactivity, as well as shared adverse outcomes, including disability, decreased quality of life, greater psychological distress, and increased mortality ( 22 , 26 ).…”

“…This is concerning, as chronic pain and multimorbidity have shared risk factors, such as age, gender, frailty, and physical inactivity, as well as shared adverse outcomes, including disability, decreased quality of life, greater psychological distress, and increased mortality ( 22 , 26 ). Multimorbidity has been associated with pain ( 21 , 23 – 25 , 27 ); however, few studies have characterized the association between pain and multimorbidity ( 27 ), for instance examining pain sites and impact on activities of daily living.…”

Physical multimorbidity and wish to die among adults aged ≥65 years: A cross-sectional analysis of the Irish Longitudinal Study on Ageing

“…Previous studies have shown that sleep problems are common in people with multimorbidity due to factors such as anxiety, stress, depression, or the symptoms per se (e.g., pain, nocturia in diabetes, and breathing problems in chronic lung disease) (Charles et al, 2011;Cheatle et al, 2016;Ferguson et al, 2020;Nutt et al, 2008 Sleep Foundation, 2020;Stubbs et al, 2018). In turn, sleep problems can increase risk for WTD, for example, through emotional dysregulation enhancing sleep difficulties, which can further enhance emotional problems, or genetic vulnerability: the same genes are involved in the regulation of circadian rhythm and in affective disorders (Koyanagi and Stickley, 2015;Mirsu-Paun et al, 2017).…”

Impact of persistent pain on function, cognition, and well‐being of older adults

“…As older adults accumulate more chronic conditions and life experiences, they also are more likely to develop chronic pain related to more than one comorbid condition, often in multiple locations in the body. 7,8 Unlike younger populations, older adults also are more likely to have more than one type of chronic pain. The BioPsycho-Social (BPS) model is a widely accepted and holistic model for the study of chronic pain; it highlights the dynamic relationships among a variety of biological, psychological, and social factors that can modulate a person's experience of chronic pain.…”