Number of Pain Sites in Older Adults Linked to Quality of Life

Marcia Frellick

June 27, 2014

The more musculoskeletal pain sites an older person has, the lower their health-related quality of life (HRQoL), according to researchers. The findings were published online June 12 in Rheumatology.

Rosie Lacey, PhD, from the Research Institute for Primary Care and Health Sciences at Keele University in the United Kingdom, and colleagues said that although the relationship has been tested in other age groups, this is the first study to include the relationship among those older than 75 years, or the "oldest old."

The relationship between number of pain sites (NPS) and HRQoL strengthened with age, but only until ages 70 to 79 years, and was not strongest among the oldest old.

The researchers mailed questionnaires to adults older than 50 years in North Staffordshire, United Kingdom, for the North Staffordshire Osteoarthritis Project. They asked participants to answer questions on mental and physical health. The researchers used the mental and physical component summary scales of the Medical Outcomes Study 12-item Short Form Health Survey to measure mental HRQoL and physical HRQoL.

Participants also shaded sites of pain that lasted more than a day in the past 4 weeks on a blank outline of the body divided into 44 mutually exclusive pain sites.

Of the 13,986 participants who completed a questionnaire, 12,408 provided complete pain data. Of those, 8890 (71.6%) of respondents reported at least 1 pain site out of a possible 44; 669 (5.4%) reported a single pain site, 8221 (66.3%) reported pain at 2 or more sites, and 6408 (51.6%) said they had pain at 4 or more sites. “The distribution of NPS in the study population showed a similar pattern for each age group," the authors write.

The median NPS reported by participants was 4 (interquartile range, 0 - 8). Linear models found a significant association between an increasing NPS and poorer mental component summary (β, −0.43; 95% confidence interval, −0.46 to −0.40) and physical component summary (β, −0.87; 95% confidence interval, −0.90 to −0.84).

One limitation of the study is that researchers used a range of pain sites from 0 to 44. Inevitably, if the blank outline had been divided into fewer pain sites, the prevalence of multiple site pain would have been lower. The authors explain that the benefit of making 44 divisions was to estimate more precisely the extent of pain in the population.

"[The study] builds on results from a study of younger adults (24–76 years old) in which there was a linear relationship between a smaller range of pain sites (1–10) and psychological distress and poor general physical and psychological health," the authors write.

They conclude that NPS represents not only a useful gauge of how much pain a person has but also potential for interventions in improving and maintaining quality of life.

The researchers say the next step would be to conduct longitudinal analyses to understand the influence of NPS on older people's mental and physical HRQoL over time.

This work was supported by the Medical Research Council, Primary Care Research West Midlands North and the North Staffordshire Primary Care Research Consortium. The authors have disclosed no relevant financial relationships.

Rheumatology. Published online June 12, 2014. Full text


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