OBJECTIVES: To determine the effects of chronic pain
on the development of disability and decline in physical
performance over time in older adults.
DESIGN: Longitudinal cohort study with 18 months of
SETTING: Urban and suburban communities.
PARTICIPANTS: Community-dwelling older adults aged
65 and older (N = 634).
MEASUREMENTS: Chronic pain assessment consisted of
musculoskeletal pain locations and pain severity and pain
interference according to the subscales of the Brief Pain
Inventory. Disability was self-reported as any difficulty in
mobility and basic and instrumental activities of daily living
(ADLs, IADLs). 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 < .001). Similar graded effects were found for other disability measures. Elderly adults with multisite or widespread pain had at a risk of onset of mobility difficulty at least three times as great as that of their peers without pain after adjusting for disability risk factors (multisite pain: risk ratio (RR) = 2.95, 95% confidence interval (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 ADL and IADL 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 substantially greater risk for developing disability over time and for clinically meaningful decline in mobility performance than those without pain.
- widespread chronic pain,
- older adults,
- mobility limitation,
- activities of daily living
Available at: http://works.bepress.com/suzanne_leveille/5/