Pain Characteristics Associated with the Onset of Disability in Older Adults: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly Boston Study

Abstract

Background/Objectives To determine the effects of chronic pain on the development of disability and decline in physical performance over time among older adults. Design Longitudinal cohort study with 18 months follow-up. Setting Urban/suburban communities Participants 634 community-dwelling older adults aged >64 years. Measurements Chronic pain assessment consisted of musculoskeletal pain locations, and pain severity and pain interference by subscales of the Brief Pain Inventory. Disability was self-reported as any difficulty in mobility and basic and instrumental activities of daily living (ADL, IADL). Mobility performance was measured using the Short Physical Performance Battery (SPPB). Relationships between baseline pain and incident disability in 18 months were determined using risk ratios (RRs) from multivariable Poisson regression models. Results Almost 65% of participants reported chronic musculoskeletal pain at baseline. New onset of mobility difficulty at 18-months was strongly associated with baseline pain distribution: 7% (no sites), 18% (1 site), 24% (multisite) and 39% (widespread pain, p-value for trend <0.001). Similar graded effects were found for other disability measures. Elders with multisite or widespread pain had at least a three-fold increased risk for onset of mobility difficulty compared to their peers without pain after adjusting for disability risk factors (multisite pain: RR=2.95, 95%CI, 1.58–5.50; widespread pain: RR=3.57, 95%CI, 1.71–7.48). Widespread pain contributed to decline in mobility performance (1 point decline in SPPB, RR=1.47, 95%CI, 1.08–2.01). Similar associations were found for baseline pain interference predicting subsequent mobility decline and (I)ADL disability. Weaker and less consistent associations were observed with pain severity. Conclusion Older community-dwelling adults living with chronic pain in multiple musculoskeletal locations have a substantial increased risk for developing disability over time and for clinically meaningful decline in mobility performance.

Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain

“…Confounding by indication and unmeasured patient characteristics is particularly relevant for research on the benefits and harms of opioids. Chronic pain is itself associated with fall and fracture risk factors, such as physical deconditioning and mobility impairment, [15][16][17][18][19]34 and with increased falling. 19,35 Even among patients with chronic pain, opioid users systematically differ from non-users; in general, they are more functionally impaired and psychosocially distressed, more likely to smoke, and less likely to be physically active.…”

“…8,9 Most prior studies have found positive associations between the use of opioid analgesics and fractures in older adults, 5,[10][11][12] but evidence for an association between opioid use and falls has been inconsistent. 13,14 Importantly, chronic musculoskeletal pain is also associated with declines in physical function [14][15][16][17][18] and increased risk of falling. 19 We used data from the Osteoporotic Fractures in Men Study (MrOS), a large prospective cohort study of communitydwelling older men, to examine longitudinal associations of opioid analgesic use with fracture and fall outcomes among older men with persistent musculoskeletal pain.…”

Chronic musculoskeletal pain in Japan (the final report of the 3-year longitudinal study): Association with a future decline in activities of daily living

“…9,10 Another study shows that elderly people with pain at multiple sites are at an increased risk of developing disability. 11 However, these studies did not show whether chronic musculoskeletal pain results in a future decline of ADL or increased certification for Needed Long-Term Care in all age groups. If chronic musculoskeletal pain alone is a risk for developing disability, controlling chronic pain is an urgent priority, particularly in countries such as Japan, which has an aging society.…”

“…A baseline questionnaire-based survey was conducted in 2010 using the mail-based survey panel maintained by Nippon Research Center, Ltd. 11 In 2013, the questionnaire was again mailed to 6119 subjects who participated in the baseline (2010) survey. The questionnaire sent out in 2013 requested both basic information (age, sex, smoking habits, drinking habits, education, and marriage) and specific information about pain (presence of pain, site of pain, intensity of pain, frequency of pain, duration of pain, treatment history, and place of treatment), ADL (basic ADL [Katz ADL], IADL [Lawton's score: males tested on a 5-point scale and females on an 8-point scale]), QOL (SF-36 scale), social loss (absence from, changes in, or quitting of work), and history of illnesses and need for care.…”

Mobilization With Movement for Shoulder Dysfunction in Older Adults: A Pilot Trial

“…1 Shoulder symptoms, such as pain and reduction in active range of motion (AROM) and functionality, might be associated to chronic pain, disability, and a decrease in physical performance over time. 1,2 Upper limbs and shoulder joint proper functionality leads to an adequate independence in activities of daily living (ADLs) and functional performance. Therefore, maintaining independence in ADL and the functional well-being in older adults should be a priority target for health care.…”