Chronic Pain May Cause Similar Disability Linked With Aging at Earlier Ages

Laurie Barclay, MD

September 29, 2009

September 29, 2009 — Younger people with pain have disability similar to that of people who are 2 to 3 decades older without pain, according to the results of a cross-sectional study published in the September issue of the Journal of the American Geriatrics Society.

"We found that the abilities of those aged 50 to 59 with pain were far more comparable to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile and 55% were able to walk several blocks, making pain sufferers appear 20 to 30 years older than non-pain sufferers," lead author Kenneth E. Covinsky, MD, MPH, from the University of California, San Francisco, said in a news release.

"After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations....Patients may be better served if pain and disability are evaluated and treated jointly rather than treated as separate issues."

The goal of this study was to evaluate the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age, among 18,531 participants in the 2004 Health and Retirement Study, a nationally representative study of community-dwelling persons 50 years and older. Significant pain was defined as pain that was moderate or severe most of the time and that often troubled the person reporting the pain.

Participants were classified based on their degree of functional limitation in each of 4 functional domains: mobility, stair climbing, upper extremity tasks, and activities of daily living function. Significant pain was reported by 24% of participants aged 50 to 59 years. In all 4 domains, rates of functional limitations were much higher in participants with pain vs those without pain.

In functional limitation, participants with pain were similar to participants 2 to 3 decades older. In the mobility domain, 37% of participants aged 50 to 59 years without pain could jog 1 mile, 91% could walk several blocks, and 96% could walk 1 block without difficulty. However, of participants aged 50 to 59 years with pain, only 9% could jog 1 mile, 50% could walk several blocks, and 69% could walk 1 block without difficulty. Mobility limitations in this group were similar to those in participants aged 80 to 89 years without pain, of whom 4% could jog 1 mile, 55% could walk several blocks, and 72% could walk 1 block without difficulty.

Participants with significant pain were at much higher risk of having functional limitations across all 4 measures, after adjustment for demographic and socioeconomic factors, comorbid conditions, depression, obesity, and health habits. Adjusted odds ratio was 2.85 for mobility (95% confidence interval [CI], 2.20 - 3.69), 2.84 for stair climbing (95% CI, 2.48 - 3.26), 3.96 for upper extremity tasks (95% CI, 3.43 - 4.58), and 4.33 for activities of daily living function (95% CI, 3.71 - 5.06).

The investigators concluded that younger subjects with pain experience functional limitations classically associated with aging.

"Our study cannot determine whether pain causes disability or whether disability causes pain," Dr. Covinsky said. "We think it is likely that both are true and that pain and disability probably can act together in ways that make both problems worsen in a downward spiral. One implication of our study is that pain and disability may not be fully separate processes, but may often be part of the same underlying process."

Limitations of this study include cross-sectional design and difficulties inherent in pain measurement.

"The drastic effect that pain can have on sufferers' abilities to carry out everyday tasks in their lives highlights the importance of managing pain and treating it effectively," said Thomas Yoshikawa, MD, editor of the Journal of the American Geriatrics Society, "Last month, we published our annual guidelines on the pharmacological management of persistent pain in older persons, and this study really brings home how essential it is for healthcare providers to be able to improve quality of life through awareness of the best treatments."

The National Institute of Arthritis and Musculoskeletal and Skin Diseases funded the Health and Retirement Study. Dr. Covinsky is supported in part by a midcareer investigator award from the National Institute on Aging. The other study authors have disclosed no relevant financial relationships.

J Am Geriatr Soc. 2009;57:1556-1561. Abstract

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