The effect of age on the onset of pain interference in a general population of older adults: Prospective findings from the North Staffordshire Osteoarthritis Project (NorStOP)
ABSTRACT Pain that interferes with daily life appears to be strongly age-related in cross-sectional studies, although the nature of this relationship over time has not been established. We have investigated the onset and persistence of pain and pain interference over a 3-year period to determine their association with age in older people. A 3-year follow-up postal survey was conducted of adults aged 50 years and over (n=5366) who had previously been recruited as part of the North Staffordshire Osteoarthritis Project. Four thousand two-hundred and thirty-four completed questionnaires were received (adjusted response 84.7%). The occurrence of pain interference at 3 years was 19.7% in persons free of such pain at baseline, higher in females than males (6.0% difference; 95% CI: 2.6%, 9.3%), and showed a clear age-related trend with a more than twofold increase from 50 to 59 years (16.0%) to the 80+ years (35%). Any pain at follow-up was reported by 48% of those pain-free at recruitment, and this figure was similar for males and females, and across 10-year age-groups. Persistence of pain interference (72.1%) at 3 years was high. In adults aged 50 years and over, the onset of pain that interferes with life shows a clear gender difference and a consistent rise with age into the oldest age-group. This was in strong contrast to the onset of pain which showed no gender or age-related trends. The implications for public health, as for the treatment of the individual, are twofold, relating to efforts to prevent disabling pain from occurring and to understand the factors that accelerate the impact which pain has on everyday life when people reach the oldest ages.
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ABSTRACT: Reporting of pain that does not interfere with life is common in the older population but little is known about people with such long-term non-interfering pain. To assess whether non-interfering pain can be a long-term state, and to compare this group with those who continuously report no pain, and with those with chronic pain that interferes with life. This was a prospective general population cohort study set within the North Staffordshire Osteoarthritis Project (NorStOP). People aged 50 plus were sent baseline, 3-year and 6-year questionnaires. Those who reported the same pain status (no pain, non-interfering pain, interfering pain) at each time point were compared on pain intensity, widespread pain and medication, and on sociodemographic and co-morbid characteristics at 6 years. Forty percent of responders reported the same pain status at each time point; 12% reported long-term non-interfering pain. Fifty-nine percent of those with non-interfering pain reported at least one site of high pain intensity, 33% reported widespread pain, and 90% had used pain medication in the past 4 weeks. This group was similar to the no-pain group but distinct on sociodemographic and co-morbid measures from those with pain that interfered. Long-term non-interfering pain is common, but despite often suffering from high pain intensity and widespread pain, those within this group seem to be able to control their pain without allowing it to affect their everyday lives. Future work is needed to assess how people with long-term pain ensure it does not cause interference with life.European journal of pain (London, England) 09/2012; 16(8):1185-94. DOI:10.1002/j.1532-2149.2012.00118.x · 3.22 Impact Factor
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ABSTRACT: Background: Chronic pain is quite common in the elderly and is often associated with comorbid depression, limitation of functioning and reduced quality of life. The aim of this study was to ascertain whether there is a differential risk of depression among persons with pain in different anatomical sites and to determine which pain conditions are independent risk factors for depression.Methods: Data are from the Ibadan Study of Ageing (ISA), a community-based longitudinal survey of persons aged 65 years and older from eight contiguous Yoruba-speaking states in Nigeria (n = 2152). Data were collected in face-to-face interviews; depression was assessed using the World Mental Health initiative version of the Composite International Diagnostic Interview (CIDI) while chronic pain was assessed by self-report (response rate = 74%).Results: Estimates of persistent pain (lasting more than six months), in different anatomical sites range from 1.3% to 12.8%, with the commonest being joint pains (12.8%), neck or back (spinal) pain (7.6%) and chest pain (3.0%). Significantly more pain conditions were reported by females and by respondents who were aged over 80 years. The risk for depression was higher in respondents with spinal, joint and chest pain. However, only chest pain was independently associated with depression after adjustments were made for pains at other sites and for functional disability.Conclusion: Our data suggests that, among elderly persons, there is a differential association of depression with chronic pain that is related to the anatomical site of the pain.International Psychogeriatrics 08/2011; 23(6):1-7. DOI:10.1017/S1041610210002322 · 1.89 Impact Factor
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ABSTRACT: Pain and symptoms of depression and anxiety have been observed to co-exist in the community-dwelling elderly. While depression and pain have been suggested to be predictive of one another temporally, the longitudinal associations between anxiety and pain remain undefined. The aim of this study was to investigate the reciprocal longitudinal associations of self-reported pain interference and affective symptoms, as measured by the Hospital Anxiety and Depression Scale, in community-dwelling older adults and report the potentially modifying effect of co-morbid anxiety or depression on these relationships. The study population were adults aged over 50-years, recruited previously to the North Staffordshire Osteoarthritis project (NorStOP), who had returned a health survey at both baseline and 3-year follow-up (n=4234). Logistic regression was used to evaluate the pain-affect associations, with associations expressed as odds ratios with 95% confidence intervals (CI). Probable depression (odds ratio=2.42; 95% CI 1.24, 4.69) and anxiety (2.30; 1.67, 3.17) at baseline predicted new-onset pain interference at 3-year follow-up. Conversely, pain interference at baseline was a risk factor for developing possible or probable depression (2.47; 1.96, 3.11) and anxiety (2.02; 1.60, 2.55) at 3-year follow-up. Adjusting for age, gender and co-morbid anxiety or depression slightly reduced the strength of the relationships, though most remained statistically significant. In conclusion, we have found evidence for both pain-depression and pain-anxiety relationships longitudinally, and in a reciprocal manner. Such findings have important implications for the future management of primary care patients presenting with symptoms of pain, anxiety or depression.European journal of pain (London, England) 04/2010; 14(9):966-71. DOI:10.1016/j.ejpain.2010.02.012 · 3.22 Impact Factor