Poor Sleep Predicts Musculoskeletal Pain in Older Adults

Lara C. Pullen, PhD

February 13, 2014

New-onset widespread pain (WP) is common in older adults and is predicted by a number of factors including baseline pain status, anxiety, and physical health–related quality of life. Nonrestorative sleep is the strongest predictor, however, for WP in this patient population, according to a new study.

John McBeth, PhD, reader in epidemiology, the Arthritis Research UK Primary Care Centre of Keele University in Staffordshire, United Kingdom, and colleagues published the results of their population-based cohort study online February 13 in Arthritis and Rheumatology. The study was designed to identify the factors associated with the development of new-onset WP.

The cohort consisted of 4326 unselected older people (≥50 years of age) who lived in a community setting. In the 3-year follow-up, 800 (18.5%) reported new WP. Sociodemographic, psychological, and clinical factors were all reasonable predictors of new-onset WP.

Increasing age was associated with a decreased likelihood of reporting new-onset WP. "The frequency of those with musculoskeletal pain increases with age but appears to stabilize or slightly decrease in those aged 70," explained author Ross Wilkie, PhD, from Keele University, to Medscape Medical News.

A multivariate analysis revealed several factors associated with new-onset WP: age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.96 - 0.99), baseline pain status (OR, 1.1; 95% CI, 1.08 - 1.2), anxiety (OR, 1.5; 95% CI, 1.01 - 2.1), physical health–related quality of life (OR, 1.3; 95% CI, 1.1 - 1.5), cognitive complaint (OR, 1.3; 95% CI, 1.04 - 1.6), and nonrestorative sleep (OR, 1.9; 95% CI, 1.2 - 2.8). The associations remained even after adjustment for osteoarthritis, which led to a modest increase in model fit (0.738 vs 0.731).

The results suggest that simply treating the patients for osteoarthritis may not be sufficient. "[T]he clinical approach to managing WP in older adults may need to move beyond focusing on treatment of [osteoarthritis] alone and consider combined interventions. This study suggests that in addition to [osteoarthritis], sleep, cognitive impairment, anxiety and physical health may be important treatment targets," the authors write.

Management and treatment of musculoskeletal pain in older adults is currently suboptimal. The current study points to the need to address underlying sleep problems to bring pain relief to this patient population.

"The clinical effectiveness of pharmacological and non-pharmacological approaches to sleep should be tested in randomized controlled trials.... Future studies should seek to identify other factors that increase the risk of developing new onset WP in older people and that may offer targets for pain reduction. Such mechanisms are likely to be multi-factorial including common factors known to be associated with reporting WP, age-specific social factors that influence pain reporting, and changes in pain processing mechanisms," the authors conclude.

The authors have disclosed no relevant financial relationships.

Arthritis Rheum. Published online February 13, 2014. Abstract

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