Physical, lifestyle, psychological, and social determinants of pain intensity, pain disability, and the number of pain locations in depressed older adults

Abstract

Late-life depression and pain more often co-occur than can be explained by chance. Determinants of pain in late-life depression are unknown, even though knowledge on possible determinants of pain in depression is important for clinical practice. Therefore, the objectives of the present study were 1) to describe pain characteristics of depressed older adults and a nondepressed comparison group, and 2) to explore physical, lifestyle, psychological, and social determinants of acute and chronic pain intensity, disability, and multisite pain in depressed older adults. Data from the Netherlands Study of Depression in Older Persons cohort, consisting of 378 depressed persons, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria, and 132 nondepressed persons aged 60 years and older, were used in a cross-sectional design. Pain characteristics were measured by the Chronic Graded Pain Scale. Multiple linear regression analyses were performed to explore the contribution of physical, lifestyle, psychological, and social determinants to outcomes pain intensity, disability, and the number of pain locations. Depressed older adults more often reported chronic pain and experienced their pain as more intense and disabling compared to nondepressed older adults. Adjusted for demographic, physical, and lifestyle characteristics, multinomial logistic regression analyses showed increased odds ratios (OR) for depression in acute pain (OR 3.010; P=0.005) and chronic pain (OR 4.544, P<0.001). In addition, linear regression analyses showed that acute and chronic pain intensity, disability, and multisite pain were associated with several biopsychosocial determinants, of which anxiety was most pronounced. Further research could focus on the temporal relationship between anxiety, late-life depression, and pain.

Prevalence of different pain categories based on pain spreading on the bodies of older adults in Sweden: a descriptive-level and multilevel association with demographics, comorbidities, medications, and certain lifestyle factors (PainS65+)

“…Disorders of the CNS were associated with the greatest pain spread categories (i.e., RP-Heavy and WSP). These results are consistent with data obtained in cross-sectional and review studies that linked those comorbidities with the development and/or maintenance of WSP 11,16,23,24,27,33,40–42,52,53. The observed strong relationship between those comorbidities and the pain categories can be partly explained by the fact that greater levels of spreading of pain trigger a tendency in health-seeking behavior more frequently than the more limited spreading of pain 24.…”

Pain severity, interference, and prescription analgesic use among depressed, low-income homebound older adults

“…The findings underscore the significant painrelated problems and the need for recognizing and treating both pain and depression more effectively for these vulnerable individuals. The biopsychosocial link between pain and depression also indicates that identification and treatment of both pain and depression is a more effective approach than focusing on either pain or depression only (Campbell et al, 2003;Hanssen et al, 2014). Specific implications of the findings are as follows:…”

“…Chest and other bodily pain complaints, sleep disturbance, insomnia, and somatic symptoms are commonly comorbid with anxiety disorders in older adults (Lenze et al, 2005;Nadorff et al, 2014;Wolitzky-Taylor et al, 2010). The presence of significantly higher depressive symptoms among users of both medications than among users of analgesics only also suggest that anxiety may have exacerbated perceptions of both pain and depression (Hanssen et al, 2014;Kroenke et al, 2013). The lack of a link between antidepressant use and analgesic use may reflect the dual use of antidepressants for antidepressant effects and for adjuvant therapy for chronic pain (e.g., fibromyalgia, neuropathic pain, rheumatoid conditions, low back pain, and headache) in current practice (Dharmshaktu, Tayal, & Kalra, 2012).…”

“…The biopsychosocial model of illness (Engel, 1977) has been used to explain pain, depression, and the link between pain and depression in older adults (Hanssen, Naarding, Collard, Comijs, & Oude Voshaar, 2014). Evidence suggests that pain and depression share common biological and psychosocial mechanisms, and a number of psychosocial factors (e.g., catastrophizing or overly negative thinking about pain, perceived helplessness, low selfefficacy, low social support, more family conflicts, lowincome) influence both chronic pain experience (e.g., pain frequency, intensity, and interference with daily life) and depression (Campbell, Clauw, & Keefe, 2003;Dersh, Polatin, & Gatchel, 2002;Goesling, Clauw, & Hassett, 2013;Wood, Nicholas, Blyth, Ashgari, & Gibson, 2013).…”

Pharmacotherapies in Geriatric Chronic Pain Management

“…As discussed in another section of this series (see Christopher Eccleston and colleagues’ article, “Psychological Approaches in Geriatric Pain Management,” in this issue), older adults with chronic pain have a substantially increased risk for depression and that depression may intensify a patient’s sensitivity to pain. 67,68 Thus, antidepressant use may have synergistic effects in older adults experiencing depression along with chronic pain. 69 …”