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Prevalence, Factors, and Health Impacts of Chronic Pain Among Community-Dwelling Older Adults in China
Abstract
Background:
Chronic pain (CP) is prevalent among older adults in many Western countries and its prevalence, factors, and self-reported or objective measured health impacts have been well documented. However, there is limited information on these aspects among Chinese community-dwelling older adults.
Aims:
Our aim was to assess the prevalence of CP and identify its associated factors as well as health impacts among older adults in China.
Design:
Cross-sectional design.
Settings:
Community settings.
Participants/subjects:
A total of 1219 community-dwelling adults aged 60 years or older.
Methods:
Data on CP, sociodemographic characteristics, comorbidity, cognitive function, and physical activity, as well as self-reported outcomes (functional disability, depression, quality of sleep, and undernutrition) and objective measured physical function, were obtained.
Results:
Among 1,219 participants, 41.1% reported CP, of whom 16.6% experienced moderate to severe pain. The risk of CP was higher among older women with comorbidity and with depression and lower among older adults with higher educational level as well as with adequate physical activity. CP had significant associations with inadequate physical activity, functional disability, depression, poorer quality of sleep, and undernutrition, as well as worsening physical performance, poorer standing balance, and chair stands.
Conclusions:
CP is a common problem among Chinese community-dwelling older adults, particularly among the most vulnerable subgroups, and has substantial impacts on self-reported functional disability, depression, poor quality of sleep, and undernutrition, as well as objective measured physical function. Therefore it is relevant for older adults to develop effective CP management programs.
... Despite the ongoing increase of individuals aged 80 and over, there is restricted knowledge regarding pain in this age bracket. This especially applies to the perception, experience and correlates of pain [2][3][4][5][6][7][8]. ...
... Following previous research based on large cohort studies (SHARE; [6,20,28]), we divided pain into three categories: no pain, moderate pain (combining mild and moderate pain) and severe pain (combining severe and very severe pain). ...
... In accordance with studies by Mallon et al. [20], Si et al. [6] and Patel et al. [15] covering ages above 85, above 60 and 65 years respectively, females had a higher risk of severe pain in our study. This clear consensus could be explained by a higher sensitivity to pain due to biological, psychological and social mechanisms. ...
Background
There is very limited knowledge regarding pain among the oldest old.
Aims
To investigate the prevalence and correlates of pain among the oldest old.
Methods
Data were taken from the “Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)”, including individuals living in North Rhine-Westphalia aged 80 years and over. Pain was categorized as no pain, moderate pain and severe pain. Its prevalence was stratified by sex, age groups, marital status, place of residence and education. A multinomial logistic regression analysis was conducted.
Results
28.50% of the participants reported no pain, 45.06% moderate pain and 26.44% severe pain. Regressions showed that being 85 years or older and a better self-rated health status decreased the likelihood of moderate pain. Being 85–89 years old, being male, highly educated and a better self-rated health status decreased the likelihood of severe pain. The likelihood of moderate and severe pain increased with a higher number of chronic diseases.
Discussion
Study findings showed a high prevalence of pain in the oldest old living in North Rhine-Westphalia, Germany. The likelihood of having moderate or severe pain was reduced among those who were older and presented with a better self-rated health but increased with a growing number of comorbidities. Severe pain was less likely among men and those with a higher education.
Conclusion
This cross-sectional representative study adds first evidence of prevalence and correlations of pain among the oldest old. Longitudinal studies are required to further explore the determinants of pain in this age group.
... Moreover, Wang, Xu [27] conducted a survey in elderly inpatients and reported that 55.5% of elderly inpatients had chronic pain. Accordingly, studies focusing on community-dwelling elderly mainly reported the prevalence of chronic pain rather than on characteristics like interference with daily life, health-seeking behaviors or conditions of medication use among the corresponding elderly [6,28]. The aforementioned studies focused on specific subpopulations or prevalence of chronic pain that had limited insights into chronic pain. ...
... Nearly half of those with chronic pain did not use medication and over half adopted nondrug therapy. Surprisingly, the prevalence of chronic pain in this study was significantly higher than previous studies conducted by Li, Chen [6] and Si, Wang [28], which respectively reported that the prevalence of chronic pain in Chinese community-dwelling elderly were 49.8 and 41.1%. The reasons why the prevalence was higher in this study may be the gap of economic and medical resources between East China and West China. ...
... The reasons why the prevalence was higher in this study may be the gap of economic and medical resources between East China and West China. Li, Chen [6] and Si, Wang [28] both recruited participants from East China whose economic and medical resources are much better than that of west China, and economic status was previously observed to influence the incidence of chronic pain [35]. Moreover, Si, Wang [28] only investigated samples from the capital city owning the best economic and medical resources in Shandong Province, leading to a lower incidence of chronic pain. ...
Background
Chronic pain adversely affects health and daily life in the elderly. Gaining insight into chronic pain that affects the community-dwelling elderly is crucial for pain management in China, which possesses the largest elderly population in the world.
Methods
This is a cross-sectional design study that followed the STROBE Guideline. A randomized cluster sampling method was used to recruit participants in the Sichuan Province from Dec 2018 to May 2019. In addition, face-to-face interviews were conducted to collect socio-demographic data, characteristics and health-seeking behaviors of chronic pain through a self-designed questionnaire.
Results
A total of 1381 older adults participated in this study. Among these participants, 791 (57.3%) had chronic pain. Here, prevalence and pain intensity were both found to increase from the 60–69 group to the 70–79 group, which then decreased in the ≥80 group with no significant differences in sex ( p > 0.05). The most common pain locations were observed in the legs/feet (53.5%), head (23.6) and abdomen/pelvis (21.1%). Among the elderly suffering from chronic pain, 29.4% sought medical help, 59.2% received medication and 59.7% adopted non-drug therapy.
Conclusion
Chronic pain is a common health concern in the Chinese community-dwelling elderly, which possesses different characteristics than other countries’ populations. Therefore, easier access to medication assistance and provision of scientific guidance for non-drug therapy may serve as satisfactory approaches in improving pain management.
... Additionally, Wang, Xu [22] conducted a survey in elderly inpatients and reported that 55.5% of elderly inpatients had chronic pain. Accordingly, studies focusing on communitydwelling elderly mainly reported on the prevalence of chronic pain rather than on characteristics like interference with daily life, health seeking behaviors or conditions of medication use among the corresponding elderly [6,23]. The aforementioned studies focused on speci c subpopulations or prevalence of chronic pain that had limited insights into chronic pain. ...
... Surprisingly, the prevalence of chronic pain in this study was found to be signi cant higher than previous studies conducted by Li,Chen [6] and Si, Wang [23], which respectively reported that the prevalence of chronic pain in Chinese community-dwelling elderly were 49.8% and 41.1%. The reasons for why the prevalence was higher in this study may be the gap of economic and medical resource between East China and West China. ...
... As we can see, Li, Chen [6] and Si, Wang [23] both recruited participants from East China whose economic and medical resources are much better than that of west China, and economic status was previously observed to in uence the incidence of chronic pain [29]. Moreover, Si, Wang [23] only investigated samples from the capital city owning the best economic and medical resources in Shandong Province, which could lead to a lower incidence of chronic pain. ...
Background: Chronic pain has adverse impacts on health and daily life in the elderly. Gaining insight into chronic pain that affects the Chinese community-dwelling elderly is important for pain management in China, which possesses the largest elderly population in the world.
Methods: This was a cross-sectional design that followed the STROBE Guideline. A randomized cluster sampling method was used to recruit participants in the Sichuan Province from Dec 2018 to May 2019. Face-to-face interviews were performed in order to collect socio-demographic data, characteristics and health seeking behaviors of chronic pain through a self-designed questionnaire.
Results: A total of 1,381 older adults participated in this study. Among these participants, 791 (57.3%) had chronic pain. Here, prevalence and pain intensity were both found to increase from the 60-69 group to the 70-79 group, which then decreased in the ≥80 group with no significant differences in sex (p>0.05). The most common pain locations were observed to be in the legs/feet (53.5%), head (23.6) and abdomen/pelvis (21.1%). Among the elderly suffering from chronic pain, only 29.4% sought medical help while 59.2% received medication and 59.7% adopted non-drug therapy.
Conclusion: Chronic pain is a common health concern in the Chinese community-dwelling elderly, which possesses different characteristics compared to populations from other countries. In this regard, easier access to medication assistance and provision of scientific guidance for non-drug therapy may serve as satisfactory approaches in improving pain management.
... Studies have shown that chronic pain can have negative consequences on health and well-being, such as malnutrition 6 and poor sleep quality 7 . A previous study reported that most older adults with chronic pain suffered from at least one sleep problem, and short sleep duration and poor sleep quality were the most common complaints 8 . ...
... Another significant finding of our study was that the female gender was an independent risk factor for chronic pain. Most previous studies revealed that women were more likely to have chronic pain, which was consistent with our study 7,25 . It is thought that women are more sensitive to pain due to differences in biological or psychological mechanisms. ...
Objective:
The effect of chronic pain on the elderly population is enormous in terms of both human suffering and cost. This study aimed to investigate the factors associated with chronic low back pain in older adults by performing a comprehensive geriatric assessment.
Methods:
This cross-sectional study included 225 elderly patients admitted to a geriatric outpatient clinic. All participants underwent a comprehensive geriatric assessment, and factors related to chronic low back pain were assessed. Participants were grouped as those with and without chronic pain.
Results:
The mean age of the participants was 72.9±6.9 years, and 149 (66.2%) of them had chronic pain complaints. The number of chronic diseases and medications, depressive symptom scores, and sleep quality scores were higher, and quality of life (European Quality of Life-5 Dimensions index and European Quality of Life-5 Dimensions visual analog scale) and nutritional status scores were lower in the chronic pain group. The pain visual analog scale score had a statistically significant moderate negative correlation with the European Quality of Life-5 Dimensions index (r=-0.440, p=0.000) and European Quality of Life-5 Dimensions visual analog scale (r=-0.398, p=0.000) scores. The male gender was associated with a reduced risk of chronic pain, while poor sleep quality and number of comorbidities were associated with an increased risk of chronic pain (p=0.000, OR 0.20, p=0.021, OR 2.54, and p=0.010, OR 1.40, respectively).
Conclusion:
Chronic pain is common and independently associated with poor sleep quality, an increased number of diseases, and female gender. The results of our study may guide pain management in older individuals.
... Pain is defined by the International Association for the Study of Pain (IASP) as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage". 1 Chronic pain refers to pain symptoms persisting for a prolonged duration of 3 months or above, which is a prevailing disorder affecting thousands of individuals across the world. [1][2][3][4][5] Increasingly high prevalence of chronic pain has been reported recently among the Chinese population, as high as 50% among the older people. 3,4,6 Central sensitization (CS) is an exaggerated response in the central nervous system. ...
... [1][2][3][4][5] Increasingly high prevalence of chronic pain has been reported recently among the Chinese population, as high as 50% among the older people. 3,4,6 Central sensitization (CS) is an exaggerated response in the central nervous system. 5,[7][8][9] The principal signature of CS is pain hypersensitivity, including allodynia, punctate and/or pressure hyperalgesia, [7][8][9] and its pathophysiological mechanisms are probably related to maladaptive brain-orchestrated sensory processing. ...
Background
Central sensitization (CS) is frequently reported in chronic pain, and the central sensitization inventory (CSI) is popularly used to assess CS. However, a validated Chinese CSI is lacking and its predictive ability for the comorbidity of central sensitivity syndromes (CSSs) remains unclear. Hence, this study aimed to generate the Chinese CSI (CSI-C) with cultural adaptation and examine its psychometric properties.
Methods
The CSI-C was formulated through forward and backward translation, panel review and piloting and then validated among patients with chronic pain (n = 235). Its internal consistency, test–retest reliability, and concurrent validity were measured. An exploratory factor analysis (EFA) was performed for the construct validity. Receiver operating characteristic (ROC) analysis was employed to determine the discriminative ability in the presence of comorbidity of CSSs.
Results
About 70% of the participants in the study experienced at least mild CS symptoms. CSI-C demonstrates a high internal consistency (Cronbach’s alpha = 0.896) and excellent test–retest reliability (ICC = 0.932). CSI-C scoring was significantly correlated with pain intensity (r = 0.188), EQ-5D index (r = −0.375), anxiety (r=0.525), and depression (r = 0.467). The EFA generated a 5-factor model, including physical symptoms, emotional distress, hypersensitivity syndromes and so on. An CSI cutoff of 42 had a sensitivity of 71.4% and a specificity of 70% for identifying chronic pain patients with ≥2 CSSs.
Conclusion
The CS manifestations are prevalent in those with persistent pain. CSI-C is a reliable and valid instrument for measuring CS. A CSI score ≥42 may predict the comorbidity of 2 or above CSSs in patients with chronic pain.
... Population-based studies have found that more than half of the older adults living in the community are suffering from pain. 1 Depression is also a common syndrome among older adults, with a prevalence of 9À20%. 2À4 Pain and depression often co-occur, with the comorbidity rate ranging from 6.9% to 13.0%. 1 Older adults with pain symptoms are more likely to develop depression. ...
... 2À4 Pain and depression often co-occur, with the comorbidity rate ranging from 6.9% to 13.0%. 1 Older adults with pain symptoms are more likely to develop depression. 5 The activity restriction model proposed by Williamson illustrates the possible mechanism of the relationship between pain and depression. ...
Objective
To examine the moderating effects of age and sex in the role of functional disability as a mediator between pain and depression.
Methods
Participants were 1917 community-dwelling older adults from Jinan, China. Data were collected on pain intensity, functional disability in activities of daily living and instrumental activities of daily living, depressive symptoms and covariates.
Results
Functional disability partially mediated the relationship between pain intensity and depressive symptoms (estimate = 0.015, SE = 0.007, 95% CI [0.004, 0.030]). Age and sex moderated both the direct and indirect effect of the mediation model. The mediating effect of functional disability was significant in the old-old men, young-old men, and young-old women, but not in the old-old women.
Conclusions
Interventions should target both pain and pain-related functional disability to improve their emotional well-being among community-dwelling older adults. Importantly, strategies should be tailored across different age and sex groups to improve their effectiveness.
... Furthermore, pain may also influence the risk of falling, through the psychological pathway. It has been reported that pain is associated with poor cognition and impaired executive function, inattention and depressed mood [12][13][14]. Since executive function and depression have been identified as risk factors for falls [8,15], the above findings suggest cognitive and emotional factors may also play a role in increasing fall risk in older people with pain. ...
... Additionally, we found that depressive symptoms were associated with falls in those with pain. Depressive symptomatology has consistently been reported to increase the risk of falling in older people [8], and several studies have reported people with depression are more likely to develop chronic pain [14,30]. Further, pain-related fear can lead to avoidance behaviors and hypervigilance to bodily sensations followed by disability, disuse and depression [31], all factors that can exacerbate fall risk. ...
(1) Background: The present study aimed to examine physical, cognitive and emotional factors affecting falls in community-dwelling older adults with and without pain; (2) Methods: Data from 789 older adults who participated in a community-based health survey were analyzed. Participants completed questionnaires on the presence of pain and previous falls. Muscle weakness (handgrip strength < 26.0 kg for men and < 18.0 kg for women) and low skeletal muscle mass (appendicular skeletal muscle mass index < 7.0 kg/m2 for men and < 5.7 kg/m2 for women) were determined. Mild cognitive impairment (MCI) and depressive symptoms were assessed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool and 15-item geriatric depression scale (GDS-15), respectively; (3) Results: In participants with pain, MCI and GDS-15 were associated with previous falls after adjusting for age, sex, education and medication use. In participants without pain, muscle weakness and low skeletal muscle mass were associated with previous falls when adjusting for the above covariates; (4) Conclusions: Falls in participants with pain were associated with cognitive and emotional factors, whereas falls in those without pain were associated with physical factors. Fall prevention interventions for older adults with pain may require tailored strategies to address cognitive and emotional factors.
... Specifically, we found that chronic pain sufferers experienced higher pain intensity in the lower back and upper back, whereas acute pain sufferers reported significantly higher pain intensity in the neck region. Additionally, while the existing literature has often emphasized the biopsychosocial comorbidities associated with chronic pain [54], our study provides new insights into how acute and chronic pain sufferers experience pain differently in terms of psychological, social, and functional impacts. We also extensively explored the impact of pain on individuals' ability, and that chronic pain sufferers reported greater feelings of guilt and a lack of empathy from others, while acute pain sufferers were more likely to struggle with work concentration. ...
Objectives: This study aimed to investigate the pain situation, functional limitations, treatment used, care-seeking behaviors, and educational preferences of adults with pain in mainland China. Methods: An online questionnaire was developed through expert validation, and participants were recruited via social media platforms. Inclusion criteria required having access to the Internet and smartphones, while individuals with significant cognitive impairments or severe mental illness were excluded. Results: 1566 participants, predominantly male (951) with a mean age of 30.24, were included. A total of 80.1% of the respondents reported experiencing pain, with over half suffering from chronic pain. Pain primarily affects the neck, lower back, and upper back, especially chronic low back pain. Pain significantly impacted various aspects of life, including mood, physical activity, work performance, family dynamics, and social relationships, particularly among chronic pain sufferers (p-value: < 0.001). Analgesics (66.9%) and self-management (80–94.3%) were the most used pain management strategies, with respondents with chronic pain reporting higher usage and effectiveness of medication than those with acute pain (p-value: < 0.001). Participants also expressed a greater interest in online education and psychotherapy interventions, especially through mobile applications. Conclusions: Chronic pain is highly prevalent in mainland China, leading to emotional distress, decreased work competency, and social isolation, with a strong demand for pain education through smartphone applications.
... Chronic pain is one of the most common health conditions worldwide in the general population (Brooks et al., 2017;Si et al., 2019;Rhodes et al., 2021) and is a source of distress and disability that affects all aspects of a patient's life. For example, chronic physical pain is linked to various psychological distress, such as anxiety, stress, and depression (Goldbart et al., 2020;Esteve et al., 2021). ...
The psychological flexibility model can be seen as a basis for an integrated and progressive psychological approach to chronic pain management. Some researchers suggest that psychological flexibility and inflexibility represent distinct processes and constructs. This meta-analysis is the first to provide a summary estimate of the overall effect size for the relationship between psychological (in)flexibility and common outcomes among chronic pain patients. The research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, https://www.crd.york.ac.uk/PROSPERO/), registration number CRD42021285705. Four databases were searched (PsycINFO; PubMed; Web of Science, CINAHL) along with reference lists. Thirty-six cross-sectional studies were included (7,779 participants). Meta-analyses (random effects model) indicated a significant medium negative association between psychological flexibility and pain intensity or functional impairment. The present study also indicated a significant small to medium association between psychological inflexibility and pain intensity, a nearly large association between psychological inflexibility and functional impairment as well as the quality of life, and a large association between psychological inflexibility and anxiety/depression. Due to the limited number of included studies, the relationship between risk behavior and psychological inflexibility may not be significant. Types of countries and instruments measuring psychological inflexibility may explain part of the heterogeneity. These findings may carry significant implications for chronic pain patients regarding the potential relationship between psychological inflexibility or flexibility and these outcomes. It may consequently form the basis for more robust testing of causal and manipulable relationships.
Systematic review registration
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285705.
... Chronic pain is one of the most common physical problems all over the world in the general population (1)(2)(3) and is a source of distress and disability that affects all aspects of a patient's life (4,5). Furthermore, individuals in a state of psychological distress experience more intense pain, leading to a reciprocal reinforcement between psychological distress and pain (5,6). ...
The previous research showed contradictions in the relationships between psychological flexibility processes and functioning. This meta-analysis is the first to provide a comprehensive meta-analysis of the associations between six core processes of psychological flexibility and functioning among chronic pain patients. Four databases were searched (PsycINFO; PubMed; CINAHL; Web of Science) along with reference lists. Thirty-six cross-sectional studies were included (7,812 chronic pain patients). A three-level meta-analytic model was used to examine the associations. The publication bias was assessed with the Egger test, funnel plot, and p-curve analysis. Significant associations were found between functioning and six processes of psychological flexibility (i.e., acceptance, defusion, present moment, committed action, self as context, and values). Except for the relationship between defusion and functioning, the relationships between the other five psychological flexibility processes and functioning were all moderated by domains of functioning. No moderators were found regarding age, percentage of females, country, or type of instrument used to measure functioning. These findings may carry significant implications for chronic pain patients and clinical workers. It might be more effective to focus on functioning-related psychological flexibility processes rather than all therapy packages if the relationships between functioning and specific processes of psychological flexibility were better informed. Limitations were also discussed.
... However, although increasing the lateral foot angle reduces knee stress towards the conclusion of the brace, it may have a negative impact at the beginning of the brace. Although not all evidence supports this claim, a limited number of studies have shown that increasing the lateral foot angle reduces end-of-support knee loading while increasing intrafrontal knee loading at the start of support [21]. Initial knee loads of support are usually higher than end-ofsupport knee loads in the KOA population, and clinical rehabilitation focuses on the first peak value of the internal knee moment. ...
The chronic pain of knee osteoarthritis in the elderly is investigated in detail in this paper, as well as the complexity of chronic pain utilising neuroimaging recognition techniques. Chronic pain in knee osteoarthritis (KOA) has a major effect on patients’ quality of life and functional activities; therefore, understanding the causes of KOA pain and the analgesic advantages of different therapies is important. In recent years, neuroimaging techniques have become increasingly important in basic and clinical pain research. Thanks to the application and development of neuroimaging techniques in the study of chronic pain in KOA, researchers have found that chronic pain in KOA contains both injury-receptive and neuropathic pain components. The neuropathic pain mechanism that causes KOA pain is complicated, and it may be produced by peripheral or central sensitization, but it has not gotten enough attention in clinical practice, and there is no agreement on how to treat combination neuropathic pain KOA. As a result, using neuroimaging techniques such as magnetic resonance imaging (MRI), electroencephalography (EEG), magnetoencephalography (MEG), and near-infrared spectroscopy (NIRS), this review examines the changes in brain pathophysiology-related regions caused by KOA pain, compares the latest results in pain assessment and prediction, and clarifies the central brain analgesic mechanistic. The capsule network model is introduced in this paper from the perspective of deep learning network structure to construct an information-complete and reversible image low-level feature bridge using isotropic representation, predict the corresponding capsule features from MRI voxel responses, and then, complete the accurate reconstruction of simple images using inverse transformation. The proposed model improves the structural similarity index by about 10%, improves the reconstruction performance of low-level feature content in simple images by about 10%, and achieves feature interpretation and analysis of low-level visual cortical fMRI voxels by visualising capsule features, according to the experimental results.
1. Introduction
Approximately 80% of the information that humans obtain from the outside world comes from vision; therefore, vision plays an irreplaceable and crucial role in the process of knowing, understanding, and transforming the external world. The eye, retina, optic nerve, lateral geniculate body, and visual cortex of the brain make up the human visual system, which is an essential component of the nervous system. The eye projects visible picture information onto the retina, which is translated into electrical impulses and transferred from the optic nerve to the brain’s visual cortex through the lateral geniculate body [1]. The visual cortex is the core of the human visual system and is mainly responsible for the advanced processing of visual information; through the hierarchical processing and processing of visual information, humans can understand the visual scene seen [2]. The processing and management of visual information in the visual cortex, which is made up of numerous nerve cells, is based on very complicated neural activity. Exploring the information processing mechanism of visual scene content in the visual cortex of the brain, analysing the characteristics of the representation of visual scene content by the neural activity of the visual cortex, and parsing the visual scene content in the neural activity of the visual cortex have been a hotspot in brain science, and it is a very important topic in the study of human visual function. In the absence of a full cure for KOA, nonpharmacological and pharmacological therapy focuses on alleviating joint discomfort and maintaining or enhancing joint function, with partial/total joint replacement surgery done only if normal joint function cannot be maintained by these techniques [3]. The lack of large-scale, standardised, cross-population epidemiologic surveys of bone and joint health, as well as the social perception of osteoarthritis as a “normal part of ageing,” the lack of medication durability and the high prevalence of complications, and the lack of large-scale, standardised, cross-population epidemiologic surveys of bone and joint health all pose challenges [4]. The absence of a large-scale, systematic, cross-population epidemiological study of bone and joint health has posed a number of difficulties to disease’s treatment. As a result, it is critical to address the disease burden issues based on patient requirements, so that more patients may benefit from standardised therapy, enhance bone and joint health, and improve their quality of life.
In the field of sports biomechanics, mechanical loading plays a crucial role in the development of KOA. Due to the high degree of difficulty and narrow application of direct in vivo measurement of knee joint loading, the knee joint internal retraction moment obtained from gait analysis tests performed by a motion capture system in conjunction with a force table system can be used as a valid and reliable golden proxy for dynamic loading of the intraknee, femorotibial intercompartmental compartment. In simple terms, during the gait support period, an external moment that causes the knee joint to invert, squeezing the medial femorotibial interval and separating the lateral interval, is generated as the ground reaction force vector is biased toward the medial compartment of the knee joint quality of life and functional activity in KOA patients, with 21.1% to 66.7% of KUA out of abnormal pain sensitivity or pain suppression in older adults worldwide. Neuroimaging techniques play an important role in identification [5]. The processing and management of visual information in the visual cortex, which is made up of numerous nerve cells, are based on very complicated neural activity. Exploring the information processing mechanism of visual scene content in the visual cortex of the brain, analysing the characteristics of the representation of visual scene content by the neural activity of the visual cortex, and parsing the visual scene content in the neural activity of the visual cortex have been a hotspot in brain science, and it is a very important topic in the study of human visual function. In the absence of a full cure for KOA, nonpharmacological and pharmacological therapy focuses on alleviating joint discomfort and maintaining or enhancing joint function, with partial/total joint replacement surgery done only if normal joint function cannot be maintained by these techniques [3]. The lack of large-scale, standardised, cross-population epidemiologic surveys of bone and joint health, as well as the social perception of osteoarthritis as a “normal part of ageing,” the lack of medication durability and the high prevalence of complications, and the lack of large-scale, standardised, cross-population epidemiologic surveys of bone and joint health all pose challenges [4]. The absence of a large-scale, systematic, cross-population epidemiological study of bone and joint health has posed a number of difficulties to disease’s treatment. As a result, it is critical to address the disease burden issues based on patient requirements, so that more patients may benefit from standardised therapy, enhance bone and joint health, and improve their quality of life. The visual cortex is an important part of the cerebral cortex. Visual information reaches the visual cortex through the human eye via the lateral geniculate body, where it is continuously processed and processed to form visual perception. The visual cortex plays an extremely critical role in the formation of vision. Neurons/nerve cells are the basic information processing units of the visual cortex. Nerve cells are mainly composed of cell bodies, dendrites, axons, and synapses, and the cell bodies and dendrites of visual neurons are concentrated in the gray matter to form the visual cortex. Many neurons form a complex neural circuit between them, which can realize complex visual information processing structures and functions, thus forming a complex visual system. The brain is divided into two hemispheres, the left hemisphere visual cortex receives information entering the right visual field and the right hemisphere visual cortex receives information entering the left visual field. The visual cortex of the brain is mainly situated in the occipital lobe, and the visual cortex is divided into regions according to the Brodmann subdivision of the brain. Visual information via the lateral geniculate body is first transmitted to the primary visual areas of the human visual cortex, and then, the output information from the primary visual areas is transmitted to the higher visual areas layer by layer through two pathways. Visual information in the visual cortex is continuously processed and processed hierarchically, i.e., visual information flows continuously from the lower visual areas to the higher visual areas, and the lower visual information features are gradually transformed into higher visual information features.
2. Current Status of Research
Degenerative lesions of articular cartilage, secondary osteophytes, and aseptic inflammatory lesions in KOA patients are the main causes of chronic pain, swelling, and stiffness in the knee joint U7I, and the symptoms gradually worsen as the disease progresses, and KOA patients often have limited joint function, which can lead to disability in severe cases [6]. Leroux et al. conducted a survey of 110 patients with osteoarthritis in a community in Shanghai and found that 27.4% of KOA patients had depressive symptoms [7]. A study by Vadivelu et al. found that 47.4% of KOA patients had anxiety or depression or both, and both anxiety and depression scores were higher than local normative levels [8]. 38.5% of older adults with osteoarthritis had depressive symptoms, as reported by Tracey et al. predictors of depression in patients with arthritis [8]. Depression and anxiety in patients with KOA are not encouraging. However, depression and anxiety symptoms often go unnoticed by health care providers, directly contributing to further decreases in inpatient QOL [9]. KOA fatigue symptoms are not routinely assessed in clinical evaluations, and patients often do not actively respond to health care providers about their fatigue. A recent study found that of 231 patients with knee or hip osteoarthritis, 47% of them had severe fatigue [10]. Fatigue can lead to reduced physical activity in KOA patients, which directly affects their motivation to participate in social activities and can negatively affect their QOL. Ravat et al. investigated the sleep status of 2682 patients with osteoarthritis and found that the prevalence of sleep disorders was approximately 71%, with insomnia being the most common sleep disorder in KOA patients [11].
The internal changes in the knee joint that result from the disease include cartilage destruction, subchondral bone thickening, and new bone reconstruction. These alterations result in discomfort, instability, stiffness, and edoema in the knee, necessitating arthroplasty [12]. The pain in the knee caused by OA is usually bilateral, occurring in and around the knee joint and spreading to the groin and anterior or lateral thighs. The symptoms of OA include decreased joint mobility, joint swelling/synovitis (fever, effusion, and synovial thickening), twisting, periarticular pressure, bone swelling, and deformity due to bone growth. OA patients have decreased ability to perform basic daily activities (e.g., climbing stairs, changing from a sitting to a standing position). The main symptoms of osteoarthritis of the knee are pain, stiffness, reduced range of motion, twisting pain, and swelling [13]. Pain in the early course of the disease is usually described as a dull intermittent pain, confined to one chamber. It usually worsens with increased activity and relieves with rest [14]. As the disease process worsens, all chambers of the femorotibial joint are involved, and joint pain becomes more constant and diffuse, with pain occurring at rest and night. The exact source of joint pain due to KOA is not known, and Dieppe and Lohmander suggest that it is essentially due to biological, psychological, and social factors [15]. Prolonged sitting and stair climbing pain suggest femoral pin joint involvement, and the above may be associated with mechanical symptoms, meniscal abnormalities, sparing osteochondral fragments, or significant joint surface abnormalities.
Pain, especially chronic pain, is a major symptom of KOA, and its effects on physical disability, motor function, and negative mood can significantly reduce patients’ quality of life and can even lead to cognitive impairments such as poor decision-making and abnormalities in the body’s sensory, emotional, and cognitive brain activity. Kellgren and Lawrence imaging categorization, illness duration, and body mass index are all variables that influence the physical condition of KOA patients, according to recent research (BMI), while the factors affecting the psychological status are mainly the disease duration. Although degenerative changes in the knee are the initial trigger for chronic pain in KOA, there is an inconsistency between local imaging of the knee and patient’s pain. In recent studies, factors such as central sensitization and neuroplasticity are coming into focus. The transformation of KOA pain from acute to chronic pain causes complex pathophysiological changes in the brain, and both structural and functional brain alterations may be present in chronic moderate and severe pain. The oil spill detection results of two oil spill identification models that consider environmental and characteristic factors are fused at the decision level using D-S evidence theory improved by fuzzy set theory, and the oil spill detection effects of the above two oil spill detection methods are analysed and compared to see how effective the decision analysis is.
3. Analysis of Neuroimaging Recognition Techniques for Assessing the Complexity of Chronic Pain in Elderly Knee Osteoarthritis
3.1. Design of Neuroimaging Recognition Techniques for Osteoarthritis of the Knee in the Elderly
When a natural picture stimuli is given to a person, the visual cortex of the brain is engaged in response (as illustrated in Figure 1). The response values of the voxels of interest distributed in the three-dimensional space of the visual cortex to the natural image stimulus can finally be obtained as a measure of the neural activity response in the corresponding region of the voxel by using fMRI to record the BOLD signal associated with the neural activity of the visual cortex [16]. The response values of many voxels in the cortex form the voxel response vector. Therefore, in this way, a series of visual cortex voxel response vectors can be obtained by continuously presenting images from the natural image database to the subjects, and they correspond to the images one by one so that the fMRI dataset corresponding to the natural image stimulus dataset can be constructed as the database for subsequent visual information parsing.
... Our findings that the participants with pain in the 40 to 49 years group had lower education levels and those with pain in the 50 to 59 years group had a higher proportion of women than those without pain are consistent with the existing literature. [30,31] Among those with pain in the ≥60 years group, the total duration of PA in October 2020 was significantly lower than that among those without pain, while the total duration of PA between April 2020 and October 2020 did not differ significantly. These findings suggest that older adults with pain had reduced PA time after the COVID-19 state of emergency. ...
Understanding the relationship between pain and physical activity (PA) levels is beneficial for maintaining good health status. However, the impact of pain on changes in PA during the coronavirus disease 2019 (COVID-19) pandemic is unknown. The purpose of this study was to examine whether PA levels pre-, during, and post-COVID-19 state of emergency differ between Japanese adults who had pain after the COVID-19 state of emergency and those who did not.
Data were collected from a cross-sectional online survey conducted between October 19 and 28, 2020. The analytic sample consisted of 1967 Japanese adults aged ≥40 years who completed the online survey. Participants completed questionnaires on the presence of pain and duration of PA, defined as the total PA time per week based on activity frequency and time. Participants were asked to report their PA at 3 time points: October 2019 (before the COVID-19 pandemic), April 2020 (during the COVID-19 state of emergency), and October 2020 (after the COVID-19 state of emergency).
Among participants aged ≥60 years who reported pain in October 2020, the total PA time was significantly lower than participants who did not report having pain. Furthermore, the total PA time in April 2020 was significantly lower than that in October 2019; however, no significant difference in total PA time was observed between April and October 2020. Among participants aged 40 to 59 years, no significant differences were observed in total PA times at the 3 time points between those with and without pain. In addition, the total PA time in October 2020 significantly increased compared to that in April 2020, although it significantly decreased in April 2020 compared to October 2019.
This study suggests that older adults with pain have lower PA levels after the COVID-19 state of emergency.
... Pallor when coupled with all those factors further causes poor nutrients and poor oxygen delivery to muscles involved in maintaining posture and performing work thus aggravating their symptoms. 19 The positive association between prevalence and age, poor socio-economic, altitude and nutritional status means that musculoskeletal disorders are likely to be an increasing public health challenge in the future. ...
Introduction: Work related musculoskeletal disorders (WRMSDs) is common among tea-plucking folks and may be attributed to the long duration of work in same posture, the load they carry while plucking and transporting the leaves to the nearest depot, improper job rotations and the difficult hilly terrains.
Objective: To determine the prevalence and pattern of musculoskeletal disorders among tea garden workers and to ascertain the risk factors for the same.
Methods: A cross-sectional study was conducted among 210 female tea garden workers employed in tea gardens of Darjeeling district using 30 cluster sampling design. Data on musculoskeletal morbidities were collected using Standard Nordic Musculoskeletal Questionnaire and ergonomic risk was assessed by Rapid Entire Body Assessment (REBA) worksheet.
Results: Proportion of musculoskeletal disorders in past 12 months was 92.4% and in past 7 days was 71.4%. Upper extremities were the most commonly affected body part. Higher altitude, age, BMI, more duration in present job, history of work related injuries and increased REBA risk assessment score were found to be significantly associated with musculoskeletal disorders.
Conclusion: Musculoskeletal morbidities among female tea garden workers of Darjeeling were found to be considerably high. Ergonomic mechanised assistance in tea plucking can reduce this proportion of MSD and thus may go a long way in reducing sickness absenteeism and increasing productivity.
Financial support and sponsorship - Nil.
Conflicts of interest - There are no conflicts of interest.
... Z a/2 = 1.96, p =0.0 339, d =0.03). This calculation is used to determine sample size in cross-sectional survey design [23], considering a sampling error of 3% and a con dence interval of 95%. To decrease the missing data, we recruited 167 KBD patients. ...
Background
Kashin-Beck Disease (KBD) is an endemic, chronic joint disease. Multisite joint pain is the primary symptom of KBD, which have profound negative effects on individuals and society. However, studies on joint pain characteristics among the KBD population are still limited. The aims of this study were to explore characteristics of joint pain in patients with KBD and determine associated factors with joint pain. Methods
This cross-sectional study included 167 patients with KBD and 169 patients from the general population with joint pain from Shaanxi Province in northwest China. Subjects were asked about joint pain characteristics and completed the numeric rating scale (NRS), the graded chronic pain scale (GCPS) and the EuroQol (EQ-5D) questionnaire. Differences between groups were determined using Chi-square, Student’s t, Mann–Whitney U and 1-way ANOVA tests.ResultsCompared with the general group, patients with KBD reported a higher number of pain sites (7.2±3.8 vs 3.5± 1.8), a higher frequency of persistent pain (98.8% vs 50.9%), a higher percentage of analgesics usage (89.2% vs 30.7%), a higher pain intensity (73.8±15.2 vs 50.0±20.7) and pain –related disability (61.2±23.3 vs 41.6±23.2), and lower EQ-5D scores (0.34±0.27 vs 0.59±0.16). Among the 167 KBD patients, painful joints were symmetrically distributed between the bilateral limbs; the 5 most frequently reported painful joints for the bilateral sides were the knees (84.8%), ankles (79.2%), wrists (51.2%), shoulders (49.5%) and elbows (47.7%). The most severe pain joint was the knee (NRS:6.6), followed by the ankles (NRS:5.1), the fingers, shoulders and elbows had the similar NRS scores (NRS:4.0). Additionally, KBD patients experienced neuropathic pain to varying degrees. Compared to males, females reported a higher number of total pain sites, higher intensity and lower quality of life. Conclusions
Besides multisite pain, the KBD patients suffered from symmetrical, persistent, and neuropathic pain. Weight-bearing joints (e.g., knee and ankle) were the most painful. These findings will provide scientific basis for establishing joint pain evaluation criteria and future pain intervention strategies for these KBD patients in China.
... Among European countries, rates of chronic pain vary from about 19% of older adults in Switzerland to 46% of older adults in France. Other countries report similar prevalence rates: 32% in Iran (Roghani, Delbari, Asadi-Lari, Rashedi, & Lokk, 2019) and 41% in China (Si et al., 2019). Given these data, the negative consequences of underrecognized and undertreated pain in older adults (Horgas, 2017) and the importance of a biopsychosocial model of pain (Miaskowski et al., 2019), accurate and meaningful assessment of pain is essential to assure pain is recognized, appropriately evaluated, and treatment planning initiated. ...
Background:
The profession of nursing has been on the front line of pain assessment and management in older adults for several decades. Self-report has traditionally been the most reliable pain assessment method, and it remains a priority best practice in identifying the presence and intensity of pain. Although advances in technology, biomarkers, and facial cue recognition now complement self-report, it is still important to maximize self-report of pain and to gather understanding of the total pain experience directly from patients. Practices in pain assessment in older adults have evolved over the past 25 years, and current research and quality improvement studies seek not only to detect the presence of pain, but also to determine the best protocol for assessment and most important pain characteristics to assess. Increasing data are now supporting two emerging practices: (1) consistently assessing the impact of pain on function, and (2) measuring pain during movement-based activities rather than at rest.
Objective:
The purpose of this article is thus to discuss the shifting paradigm for movement-based pain assessment in older adults, as well as the practice, policy, and regulatory drivers that support this practice change.
This study investigates the long-term effects of loneliness on pain experiences in older Chinese adults, focusing on the mediating role of depression. Data from the China Health and Retirement Longitudinal Study (2013–2020) included 1,592 participants aged 60 and above. Using robust mixed-effects logistic regression models, the study found that lonely participants were more likely to experience 12 site pain: headache (OR 1.23; 95% CI 1.09–1.39), shoulder (OR 1.16; 95% CI 1.04–1.30), wrist (OR 1.14; 95%CI 1.01–1.28), finger (OR 1.14, 95% CI 1.02–1.28), chest (OR 1.26; 95% CI 1.10–1.44), stomach (OR 1.28, 95% CI 1.12–1.46), back (OR 1.23; 95% CI 1.00–1.51), waist (OR 1.46; 95% CI 1.17–1.83), buttock (OR 1.15, 95% CI 1.02–1.30), leg (OR 1.20, 95% CI 1.08–1.33), knee (OR 1.16; 95% CI 1.04–1.30), and toe (OR 1.18; 95% CI 1.04–1.34) than participants who were not lonely. No such finding was found for neck, arm, or ankle pain. The risk of pain due to loneliness did not decrease with an increase in the frequency of social activities. These findings emphasize the need to address mental health as a crucial factor in pain prevention and management.
Chronic pain and depression are highly prevalent and correlated in older adults. Acceptance and commitment therapy (ACT) and exercise have been shown to be effective for both conditions, mostly in Western literature. Little is known about integrating two approaches, particularly in Asian cultures and among less well-educated people. This article describes the iterative process of developing a culturally adapted ACT with exercise intervention for older Chinese with chronic pain and depressive symptoms. A multidisciplinary expert panel codesigned a culturally adapted ACT with exercise intervention, comprising a weekly 2-hr ACT and a 1½-hr exercise program for 8 weeks, focusing on six ACT core components and low-to-moderate intensity circuit-based resistance exercise. Its feasibility was tested through a mixed-methods, pretest–posttest design with 22 older Chinese experiencing chronic pain and depressive symptoms (Mage = 71.5 years, SD = 7.5, 86% female). Participants showed significant improvements in pain intensity, pain interference, pain self-efficacy, physical performance, pain acceptance, and committed action (all p < .05). We identified five themes to inform protocol revision: (1) contextualizing values, (2) utilizing experiential learning, (3) using culturally appropriate metaphors, (4) establishing linkage between ACT concepts and pain, and (5) promoting application through repetition and prompts. Incorporating these findings, the final protocol emphasized three core ACT components and one set of physical exercises. This is the first study demonstrating the feasibility of a culturally adapted, person-centered tailoring ACT with exercise intervention for improving pain-related outcomes and mental wellness among older Chinese.
Chronic pain in elderly individuals, particularly in rural areas, presents a complex challenge requiring interdisciplinary solutions. The World Health Organization highlights its widespread nature, with its prevalence influenced by regional and demographic variables. China, experiencing rapid demographic aging, faces heightened challenges in this realm. The understanding of chronic pain has deepened over time, encompassing not just physical but also psychological, social, and economic facets. Rural elderly populations confront exacerbated pain management issues due to healthcare limitations, cultural beliefs, and economic constraints. These often lead to inadequate diagnosis and treatment. Traditional Chinese values and philosophies add layers to pain perception in rural China. The repercussions of chronic pain are significant, impacting physical health, mental state, social engagement, and financial well-being. An interdisciplinary healthcare approach, emphasizing comprehensive assessment, individualized management, education, psychosocial support, and community engagement, emerges as a pivotal strategy to enhance the life quality of these older adults.
Background
The decline in intrinsic capacity (IC) among older adults is a significant global health challenge, impacting their well-being and quality of life. Despite global efforts to promote healthy aging, research on factors contributing to IC decline in the Chinese population is limited. This study aims to investigate the decline of intrinsic capacity in Chinese older adults and to explore the influence of sociodemographic, health status, and lifestyle factors on the decline of intrinsic capacity.
Methods
Prevalence of intrinsic capacity decline was described using frequency analysis, while chi-square tests were used to analyze its associations with sociodemographic characteristics, health status, and lifestyle factors. Binary logistic regression analysis was used to identify significant factors influencing the decline of intrinsic capacity (α = 0.05).
Results
Among 6,941 respondents aged 60 years and above, 83.8% reported a decline in intrinsic capacity. Cognitive impairment was predominant (71.8%), followed by psychological (40.4%), locomotion (19.8%), vitality (17.2%), and sensory impairments (8.9%). Sociodemographic factors associated with a decline in intrinsic capacity included female gender, age 80 and older, unmarried, divorced or widowed status, rural residence, low education, and lack of health or pension insurance (p < 0.05). From the perspective of health status, factors associated with higher rates of intrinsic capacity decline include poor self-rated health, multiple chronic conditions, recent falls, frequent physical pain, recent outpatient visits, hospitalizations, and pessimistic life expectancy (p < 0.05). Lifestyle factors such as alcohol consumption, lack of social participation, prolonged sleep duration, and no Internet use were also linked to higher rates of intrinsic capacity decline (p < 0.05). The results of the binary logistic regression indicated that age, marital status, residence address, education level, pension insurance status, self-rated health, the presence of multiple chronic conditions, frequency of perceived physical pain, subjective life expectancy, social participation, sleep duration, and Internet access significantly influenced the decline of intrinsic capacity in older adults (p < 0.05).
Conclusions
The decline in intrinsic capacity among older adults in China, particularly in cognitive impairment, is concerning. Targeted interventions are necessary for vulnerable populations, especially those who are older, divorced or widowed, living in rural areas, or have lower education levels. Enhancing social pensions, promoting social participation, encouraging healthy sleep patterns, and improving digital inclusion to improve intrinsic capacity among older adults is important.
Objectives
Sarcopenia and chronic pain are geriatric syndromes that negatively impact the lives of older people. The aim of this study was to explore the relationship among sarcopenia, pain, and successful aging among older persons participating in the China Health and Retirement Longitudinal Study (CHARLS).DesignCohort study with a 2-year follow-up.Setting and Participants|Data were derived from 2 waves of the CHARLS, and 4280 community-dwelling participants aged ≥ 60 years were included in the studyMethods
Sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Successful aging was defined following Rowe and Kahn’s multidimensional model. Pain was assessed by a self-reported questionnaire. A generalized estimating equation (GEE) was used to examine the associations.ResultsLongitudinal results demonstrated that compared with no sarcopenia, possible sarcopenia [OR (95%CI): 0.600 (0.304~1.188)] was not significantly associated with successful aging. Pain only was strongly associated with successful aging [0.388 (0.251~0.600)], whereas the association between sarcopenia only and successful aging was weaker [0.509 (0.287~0.905)]. The likelihood of being successful aging was substantially lower in the presence of coexisting sarcopenia and pain [0.268 (0.108~0.759)].Conclusions
Both pain and sarcopenia are significant predictors for achieving successful aging among community-dwelling older adults. Early identification of sarcopenia and pain permits the implementation of treatment strategies and presents an opportunity to mitigate the risk of being unsuccessful aging.
Objectives
The Coronavirus Disease 2019 (COVID-19) pandemic has profound negative effects on the mental health of clinically stable older patients with psychiatric disorders. This study examined the influential nodes of psychiatric problems and their associations in this population using network analysis.
Methods
Clinically stable older patients with psychiatric disorders were consecutively recruited from four major psychiatric hospitals in China from May 22 to July 15, 2020. Depressive and anxiety syndromes (depression and anxiety hereafter), insomnia, posttraumatic stress symptoms (PTSS), pain, and fatigue were measured using the Patient Health Questionnaire, General Anxiety Disorder, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist - Civilian Version, and Numeric Rating Scales for pain and fatigue, respectively.
Results
A total of 1063 participants were included. The network analysis revealed that depression was the most influential node followed by anxiety as indicated by the centrality index of strength. In contrast, the edge connecting depression and anxiety was the strongest edge, followed by the edge connecting depression and insomnia, and the edge connecting depression and fatigue as indicated by edge-weights. The network structure was invariant by gender based on the network structure invariance test (M = .14, P = .20) and global strength invariance tests (S = .08, P = .30).
Conclusions
Attention should be paid to depression and its associations with anxiety, insomnia, and fatigue in the screening and treatment of mental health problems in clinically stable older psychiatric patients affected by the COVID-19 pandemic.
Pain is a common problem for many older adults. Estimates are that more than 50% of older adults experience pain on a regular basis. We provide an overview of pain, including definitions, types of pain, and pain theories and their evolution over time. The study of pain and aging is relatively new, and a history of this area of clinical and research attention is reviewed. We discuss the epidemiology of pain in older adults, age-changes in pain, factors that contribute to pain, and consequences of pain in this population. Pain management requires systematic assessment and effective pain treatment. Strategies for measuring pain are described, including an overview of pain assessment in people with dementia, an area in which substantial advancements have been made. Pain treatment is optimized when a combination of pharmacological and nonpharmacological strategies are used; an overview of pain treatment options is presented.
Purpose
To examine the “age-related positivity effect” and its sex differences in the pain-depression relationship among Chinese community-dwelling older adults.
Design
Cross-sectional design.
Methods
The study was conducted with a sample of 1,913 older adults in Jinan, China. Data were collected on pain intensity, age, sex, depressive symptoms, and potential covariates.
Results
The hierarchical linear regression analyses revealed that pain intensity was significantly related to depressive symptoms, there was a significant two-way interaction between age and pain intensity, and there was a significant three-way interaction between sex, age, and pain intensity. The Johnson-Neyman plot revealed that the relationship between pain and depressive symptoms decreased with advancing age, indicating an “age-related positivity effect.” And the age-related positivity effect in the pain-depression relationship was significant only in men, but not in women.
Conclusions
The study suggests that all older women and “young-old” men (younger senior citizens aged 60-79) in China are more likely to experience depressive symptoms from pain. Interventions on cognitive psychology should particularly target all older women and young-old men to reduce the detrimental effect of pain on emotional well-being.
Objective
To develop and evaluate the psychometric properties of an instrument assessing beliefs in physical activity based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) among (pre)frail older adults.
Methods
A literature review and semi-structured interviews were conducted to generate the initial item pool of the instrument. A rural sample of 611 (pre)frail older adults was enrolled to examine the validity and reliability of the instrument.
Results
The exploratory factor analysis extracted eight factors for this instrument, explaining 71.3% of the variance in beliefs in physical activity. The confirmatory factor analysis confirmed the eight-factor structure. Linear regression models found that the integrated HBM-TPB constructs explained 65.9% of the variance in physical activity intention and 13.6% in physical activity. The Cronbach’s alpha coefficients for the factors ranged from 0.80 to 0.98, and ICCs ranged from 0.71 to 0.85.
Conclusion
This instrument has satisfactory construct validity, predictive validity, internal consistency reliability and test-retest reliability, and it can be used in (pre)frail older adults to measure beliefs in physical activity.
Practice implications
This instrument may help health care providers understand beliefs in physical activity and facilitate targeted interventions among (pre)frail older adults.
Purpose of ReviewTo characterize pain prevalence in older adults, particularly high-impact chronic pain, and examine the presence of multimorbidity and its relationship with and impact on chronic pain.Recent FindingsThis review found that chronic pain is highly prevalent in older adults; however, high-impact pain appears to be less prevalent based on recent studies. In addition, it was found that risk factors for multimorbidity and chronic pain experiences include causal factors (e.g., lifestyle, injury, medications and treatments, and/or surgery) and contributing factors (e.g., biological, psychological, and environmental). The consequences of both multimorbidity and chronic pain experiences include functional impairment, psychological distress, symptom severity and burden, medication use, decreased quality of life, and sleep disturbance.SummaryThis article addressed pain prevalence in older adults and the relationship between pain and multimorbidity. Risk factors and consequences of pain and multimorbidity were identified and recommendations for future research were provided.
Background
Studies have shown that physical interventions and psychological methods based on the cognitive behavioral approach are efficacious in alleviating pain and that combining both tends to yield more benefits than either intervention alone. In view of the aging population with chronic pain and the lack of evidence-based pain management programs locally, we developed a multicomponent intervention incorporating physical exercise and cognitive behavioral techniques and examined its long-term effects against treatment as usual (i.e., pain education) in older adults with chronic musculoskeletal pain in Hong Kong.
Methods/design
We are conducting a double-blind, cluster-randomized controlled trial. A sample of 160 participants aged ≥ 60 years will be recruited from social centers or outpatient clinics and will be randomized on the basis of center/clinic to either the multicomponent intervention or the pain education program. Both interventions consist of ten weekly sessions of 90 minutes each. The primary outcome is pain intensity, and the secondary outcomes include pain interference, pain persistence, pain self-efficacy, pain coping, pain catastrophizing cognitions, health-related quality of life, depressive symptoms, and hip and knee muscle strength. All outcome measures will be collected at baseline, postintervention, and at 3 and 6 months follow-up. Intention-to-treat analysis will be performed using mixed-effects regression to see whether the multicomponent intervention alleviates pain intensity and associated outcomes over and above the effects of pain education (i.e., a treatment × time intervention effect).
Discussion
Because the activities included in the multicomponent intervention were carefully selected for ready implementation by allied health professionals in general, the results of this study, if positive, will make available an efficacious, nonpharmacological pain management program that can be widely adopted in clinical and social service settings and will hence improve older people’s access to pain management services.
Trial registration
Chinese Clinical Trial Registry, ChiCTR-IIR-16008387. Registered on 28 April 2016.
Background and objective
There is limited knowledge about the prevalence of pain and its relation to comorbidities, medication, and certain lifestyle factors in older adults. To address this limitation, this cross-sectional study examined the spreading of pain on the body in a sample of 6611 subjects ≥65 years old (mean age = 75.0 years; standard deviation [SD] = 7.7) living in southeastern Sweden.
Methods
Sex, age, comorbidities, medication, nicotine, alcohol intake, and physical activity were analyzed in relation to the following pain categories: local pain (LP) (24.1%), regional pain medium (RP-Medium) (20.3%), regional pain heavy (RP-Heavy) (5.2%), and widespread pain (WSP) (1.7%).
Results
RP-Medium, RP-Heavy, and WSP were associated more strongly with women than with men (all p<0.01). RP-Heavy was less likely in the 80–84 and >85 age groups compared to the 65–69 age group (both p<0.01). Traumatic injuries, rheumatoid arthritis/osteoarthritis, and analgesics were associated with all pain categories (all p<0.001). An association with gastrointestinal disorders was found in LP, RP-Medium, and RP-Heavy (all p<0.01). Depressive disorders were associated with all pain categories, except for LP (all p<0.05). Disorders of the central nervous system were associated with both RP-Heavy and WSP (all p<0.05). Medication for peripheral vascular disorders was associated with RP-Medium (p<0.05), and hypnotics were associated with RP-Heavy (p<0.01).
Conclusion
More than 50% of older adults suffered from different pain spread categories. Women were more likely to experience greater spreading of pain than men. A noteworthy number of common comorbidities and medications were associated with increased likelihood of pain spread from LP to RP-Medium, RP-Heavy, and WSP. Effective management plans should consider these observed associations to improve functional deficiency and decrease spreading of pain-related disability in older adults.
OBJECTIVE: The aim of the study was to analyze health-related factors associated with poor nutritional status (PNS) of a representative group of Polish older people, based on data from the PolSenior project (the first nation-wide study of Polish senior citizens).
PATIENTS AND METHODS: Nutritional status was assessed in 3751 community-dwelling older people (1770 females, mean age: 77.4±8.0 years) using the Mini Nutritional Assessment – Short Form. Elements of comprehensive geriatric assessment (cognitive and mood screening), selected medical data were analyzed in relation to the nutritional status. These were: the number of medications, the number of chronic diseases, selected diseases potentially related to malnutrition (anaemia, stroke, peptic ulcer, Parkinson’s disease, cancer – past or present), total edentulism, use of dentures, and chronic pain.
RESULTS: PNS was observed in 44.2% of participants. Female sex [OR 1.72, 95% Cl (1.45-2.04)], advanced age [OR 2.16 (1.80-2.58)], symptoms of depression [OR 11.52 (9.24-14.38)], cognitive impairment [OR 1.52 (1.20-1.93], multimorbidity [OR 1.27 (1.04-1.57)], anaemia [OR 1.80 (1.41-2.29)] and total edentulism [OR 1.26 (1.06-1.49)] were independently correlated with PNS.
CONCLUSIONS: PNS in Polish elderly population is strongly related to the occurrence of symptoms of depression. People in advanced age with symptoms of depression, cognitive impairment, multimorbidity, anaemia and total edentulism should be screened and monitored for early symptoms of malnutrition.
Depression is a common feature of chronic pain, but the content of depressed cognitions in groups with chronic pain may be qualitatively different from other depressed groups. Future thinking has been extensively studied in depressed population, however, to our knowledge this is the first study to investigate future thinking, using a verbal fluency task, in chronic pain. This study investigated the content of cognitions about the future, which are postulated to be a key mechanism in the development of clinical depression, but have not been studies in groups with chronic pain. The present study used the Future Thinking Task (FTT) to investigate general future thinking and health-related future thinking in 4 groups of participants: those with pain and concurrent depression, those with pain without depression, those with depression without pain, and healthy control participants. 172 participants generated positive and negative future events, and rated the valence and likelihood of these events. Responses were coded for health-related content by two independent raters. Participants with depression (with and without pain) produced more negative and less positive future events than control participants. Participants with pain (depressed and non-depressed) produced more positive health-related future events than control participants. Participants with depression and pain produced more negative health-related future events than the non-depressed pain group. The findings suggest that participants with pain and depression exhibit a cognitive bias specific to negative aspects of health-related future thinking. This focus facilitates understanding of the relationship between depression and pain processing. The implications for therapeutic interventions are discussed.
To explore the level of physical activity in a population based sample of older adults; to analyze the influence of pain characteristics and fear-avoidance beliefs as predictors of physical activity among older adults reporting chronic pain.
Demographics, pain characteristics (duration, intensity), physical activity, kinesiophobia (excessive fear of movement/(re) injury), self-efficacy and self-rated health were measured with questionnaires at baseline and 12-months later. Logistic regression analyses were done to identify associations at baseline and predictors of physical activity 12-months later during follow-up.
Of the 1141 older adults (mean age 74.4 range 65–103 years, 53.5 % women) included in the study, 31.1 % of those with chronic pain were sufficiently active (scoring ≥ 4 on Grimby’s physical activity scale) compared to 56.9 % of those without chronic pain. Lower age (OR = 0.93, 95 % CI = 0.88-0.99), low kinesiophobia OR = 0.95, 95 % CI = 0.91–0.99), and higher activity level at baseline (OR = 10.0, 95 % CI = 4.98–20.67) significantly predicted higher levels of physical activity in individuals with chronic pain.
The level of physical activity was significantly lower among those with chronic pain and was significantly associated with kinesiophobia. Our findings suggest that fear- avoidance believes plays a more important role in predicting future physical activity levels than pain characteristics. Thus our findings are important to consider when aiming to increase physical activity in older adults that have chronic pain.
Objectives: To assess the validity (convergent and construct) and reliability of the Short Physical Performance Battery (SPPB) among non-disabled adults between 65 to 74 years of age residing in the Andes Mountains of Colombia. Methods: Design: Validation study; Participants: 150 subjects aged 65 to 74 years recruited from elderly associations (day-centers) in Manizales, Colombia. Measurements: The SPPB tests of balance, including time to walk 4 meters and time required to stand from a chair 5 times were administered to all participants. Reliability was analyzed with a 7-day interval between assessments and use of repeated ANOVA testing. Construct validity was assessed using factor analysis and by testing the relationship between SPPB and depressive symptoms, cognitive function, and self rated health (SRH), while the concurrent validity was measured through relationships with mobility limitations and disability in Activities of Daily Living (ADL). ANOVA tests were used to establish these associations. Results: Test-retest reliability of the SPPB was high: 0.87 (CI95%: 0.77-0.96). A one factor solution was found with three SPPB tests. SPPB was related to self-rated health, limitations in walking and climbing steps and to indicators of disability, as well as to cognitive function and depression. There was a graded decrease in the mean SPPB score with increasing disability and poor health. Conclusion: The Spanish version of SPPB is reliable and valid to assess physical performance among older adults from our region. Future studies should establish their clinical applications and explore usage in population studies.
Chronic pain is recognized as a public health problem that affects the general population physically, psychologically, and socially. However, there is little knowledge about the associated factors of chronic pain, such as the influence of weather, family structure, daily exercise, and work status.
This survey had three aims: 1) to estimate the prevalence of chronic pain in Japan, 2) to analyze these associated factors, and 3) to evaluate the social burden due to chronic pain.
We conducted a cross-sectional postal survey in a sample of 6000 adults aged ≥20 years. The response rate was 43.8%.
The mean age of the respondents was 57.7 years (range 20-99 years); 39.3% met the criteria for chronic pain (lasting ≥3 months). Approximately a quarter of the respondents reported that their chronic pain was adversely influenced by bad weather and also oncoming bad weather. Risk factors for chronic pain, as determined by a logistic regression model, included being an older female, being unemployed, living alone, and no daily exercise. Individuals with chronic pain showed significantly lower quality of life and significantly higher psychological distress scores than those without chronic pain. The mean annual duration of absence from work of working-age respondents was 9.6 days (range 1-365 days).
Our findings revealed that high prevalence and severity of chronic pain, associated factors, and significant impact on quality of life in the adult Japanese population. A detailed understanding of factors associated with chronic pain is essential for establishing a management strategy for primary care.
Aims/objectives/background:
A significant number of people who experience chronic pain also complain of depression and sleep problems. The comorbidities and bidirectional relationships that exist between these ailments are well recognized clinically. Further, all 3 disorders involve similar alterations in structural and functional neurobiology and share common pathophysiological mechanisms. We sought to comprehensively review the research literature regarding common neurobiological factors associated with these complex clinical disorders in order to better understand how they are related and provide further rationale for future clinical and research efforts to appropriately understand and manage them.
Methods:
A comprehensive review of the existing research literature was conducted in the domains of chronic pain, depression, and sleep.
Results:
Although the neurobiological underpinnings of these factors are complex and require further investigation, comparable changes are seen in levels of serotonin (5-hydroxytryptamine), proinflammatory cytokines, brain-derived neurotrophic factor, and other transmitters in these disorders.
Conclusions:
This review is unique as it attempts to cast a broader net over the common neurobiological correlates that exist across these 3 conditions. It highlights the complexity of the interrelationships between these disorders and the importance of increasing our understanding of neurobiological factors associated with them.
To determine whether long-term physical activity is safe for older adults with knee pain.
A comprehensive systematic review and narrative synthesis of existing literature was conducted using multiple electronic databases from inception until May 2013. Two reviewers independently screened, checked data extraction and carried out quality assessment. Inclusion criteria for study designs were randomised controlled trials (RCTs), prospective cohort studies or case control studies, which included adults of mean age over 45 years old with knee pain or osteoarthritis (OA), undertaking physical activity over at least three months and which measured a safety related outcome (adverse events, pain, physical functioning, structural OA imaging progression or progression to total knee replacement (TKR)).
Of the 8614 unique references identified, 49 studies were included in the review, comprising 48 RCTs and one case control study. RCTs varied in quality and included an array of low impact therapeutic exercise interventions of varying cardiovascular intensity. There was no evidence of serious adverse events, increases in pain, decreases in physical function, progression of structural OA on imaging or increased TKR at group level. The case control study concluded that increasing levels of regular physical activity was associated with lower risk of progression to TKR.
Long-term therapeutic exercise lasting three to thirty months is safe for most older adults with knee pain. This evidence supports current clinical guideline recommendations. However, most studies investigated selected, consenting older adults carrying out low impact therapeutic exercise which may affect result generalizability.
PROSPERO 2014:CRD42014006913.
Copyright © 2015. Published by Elsevier Ltd.
To estimate the prevalence of chronic pain and its association with socioeconomic and demographic status, and leisure physical activity in the elderly population.
This study is part of an epidemiological cross-sectional population-based household survey called EpiFloripa Elderly 2009-2010, which was conducted with 1,705 elderly individuals (≥ 60 years) residents of Florianópolis, Santa Catarina. From the positive response to chronic pain, the associations with the variables were investigated through a structured interview. Descriptive statistics were conducted, including ratio calculation and 95% confidence intervals. In crude and adjusted analysis, Poisson regression was utilized, estimating prevalence ratios, with 95% confidence intervals and ≤ 0.05 p-values.
Among the subjects, 29.3% (IC95% 26.5 - 32.2) reported chronic pain. Adjusted analysis showed that being female, having less years of schooling, and being in worse economic situation were significantly associated with a higher prevalence of chronic pain. Being physically active during leisure time was significantly associated with lower prevalence of the outcome.
Therefore, it is clear that chronic pain affects a considerable amount of elderly individuals. Social inequalities are a harmful influence in these individuals' quality of life, inasmuch as those inequalities increase the frequency with which chronic pain afflicts them. At the same time, physical activity during leisure time decreases chronic pain frequency. It is fundamental that public health policies subsidize multidisciplinary pain management programs, which should include health targeted physical activity for the elderly, thus preventing the decrease in quality of life that chronic pain brings to this population.
Objectives. To describe and explore current exercise and physical activity behaviour in older adults with knee pain in the UK.
Methods. A survey was mailed to 2234 adults ≥50 years of age registered with one general practice within the UK to determine the presence and severity of knee pain and levels of physical activity. Semi-structured interviews were conducted with 22 questionnaire responders with knee pain.
Results. The questionnaire response rate was 59% (n = 1276) and 611 respondents reported knee pain. Only ∼40% of individuals with knee pain were sufficiently active to meet physical activity recommendations. Interviews revealed individual differences in the type and setting of physical activity completed and some self-monitored their symptoms in response to physical activity in order to guide future behaviour.
Conclusion. Innovative interventions that can be adapted to suit individual needs and preferences are required to help older adults with knee pain become more physically active.
Objectives:
To assess the validity (convergent and construct) and reliability of the Short Physical Performance Battery (SPPB) among non-disabled adults between 65 to 74 years of age residing in the Andes Mountains of Colombia.
Methods:
Design Validation study;
Participants:
150 subjects aged 65 to 74 years recruited from elderly associations (day-centers) in Manizales, Colombia.
Measurements:
The SPPB tests of balance, including time to walk 4 meters and time required to stand from a chair 5 times were administered to all participants. Reliability was analyzed with a 7-day interval between assessments and use of repeated ANOVA testing. Construct validity was assessed using factor analysis and by testing the relationship between SPPB and depressive symptoms, cognitive function, and self rated health (SRH), while the concurrent validity was measured through relationships with mobility limitations and disability in Activities of Daily Living (ADL). ANOVA tests were used to establish these associations.
Results:
Test-retest reliability of the SPPB was high: 0.87 (CI95%: 0.77-0.96). A one factor solution was found with three SPPB tests. SPPB was related to self-rated health, limitations in walking and climbing steps and to indicators of disability, as well as to cognitive function and depression. There was a graded decrease in the mean SPPB score with increasing disability and poor health.
Conclusion:
The Spanish version of SPPB is reliable and valid to assess physical performance among older adults from our region. Future studies should establish their clinical applications and explore usage in population studies.
Background/objectives
The impact of pain on the physical performance of patients in aged care rehabilitation is not known. The study sought to assess 1) the prevalence of pain in older people being discharged from inpatient rehabilitation; 2) the association between self-reported pain and physical performance in people being discharged from inpatient rehabilitation; and 3) the association between self-reported pain and physical performance in this population, after adjusting for potential confounding factors.
Methods
This was an observational cross-sectional study of 420 older people at two inpatient aged care rehabilitation units. Physical performance was assessed using the Lower Limb Summary Performance Score. Pain was assessed with questions about the extent to which participants were troubled by pain, the duration of symptoms, and the impact of chronic pain on everyday activity. Depression and the number of comorbidities were assessed by questionnaire and medical file audit. Cognition was assessed with the Mini-Mental State Examination.
Results
Thirty percent of participants reported chronic pain (pain lasting more than 3 months), and 17% reported that this pain interfered with daily activities to a moderate or greater extent. Chronic pain (P=0.013) and chronic pain affecting daily activities (P<0.001) were associated with a poorer Lower Limb Summary Performance Score. The relationship between chronic pain affecting daily activities and Lower Limb Summary Performance Score remained significant (P=0.001) after adjusting for depression, age, comorbidities, and Mini-Mental State Examination score. This model explained 10% of the variability in physical performance.
Conclusion
One-third of participants reported chronic pain, and close to one-fifth reported that this pain interfered with daily activities. Chronic pain was associated with impaired physical performance, and this relationship persisted after adjusting for likely confounding factors.
This manual is intended for those involved the design and implementation of surveys to assess vitamin and mineral deficiencies, as well as the planning, implementation, analysis, and reporting of survey results. Included are the procedures and tools necessary to undertake a cross-sectional survey that will provide estimates of the prevalence of iron deficiency anemia, iodine and vitamin A deficiency. Such surveys are usually carried out periodically to provide information that should lead to advocacy and appropriate intervention strategies. When carried out sequentially, surveys can be used to track progress of prevention and control efforts over time.
Information on the coverage of prevention and control programs (such as vitamin A capsule distribution, salt iodization, and flour fortification) are also included.
Objectives: This study aimed to assess the nutritional status, measured by MNA, and its association
with socio-demographic indicators and health related characteristics of a representative sample of community dwelling elderly subjects. Design: Cross-sectional study. Setting: Community dwelling elderly individuals living in rural communities in Lebanon. Participants: 1200 elderly individuals aged 65 years or more. Measurements: Socio-demographic indicators and health related characteristics were recorded during a standardized interview. Nutritional status was assessed through Mini Nutritional Assessment (MNA). The 5-item GDS score and the WHO-5-A score were used to assess mood, whereas Mini Mental Status (MMS) was applied to evaluate cognitive status. Results: The prevalence of malnutrition and risk of malnutrition was 8.0% respective 29.1% of the study sample. Malnutrition was significantly more frequent in elderly subjects aged more than 85 years, in females, widowed and illiterate people. Moreover, participants who reported lower financial status were more often malnourished or at risk of malnutrition. Regarding health status, poor nutritional status was more common among those reporting more than three chronic diseases, taking more than three drugs daily, suffering from chronic pain and those who had worse oral health status. Also, depressive disorders and cognitive dysfunction were significantly related to malnutrition. After multivariate analysis following variables remained independently associated to malnutrition: living in the governorate of Nabatieh (ORa 2.30, 95% CI 1.35 -3.93), reporting higher income (ORa 0.77, 95% CI 0.61-0.97), higher number of comorbidities (ORa 1.22, 95% CI 1.12-1.32), chronic pain (ORa 1.72, 95% CI 1.24-2.39), and depressive disorders (ORa 1.66, 95% CI 1.47-1.88). On the other hand, better cognitive functioning was strongly associated with decreased nutritional risk (ORa 0.27, 95%CI 0.17- 0.43). Conclusion: Our results highlighted the close relationship between health status and malnutrition. The
identification of potential predictive factors may allow better prevention and management of malnutrition in
elderly people.
This study sought to determine the prevalence and impact of pain in a nationally representative sample of older adults in the United States. Data from the 2011 National Health and Aging Trends Study were analyzed. In-person interviews were conducted in 7601 adults ages ⩾65years. The response rate was 71.0% and all analyses were weighted to account for the sampling design. The overall prevalence of bothersome pain in the last month was 52.9%, afflicting 18.7 million older adults in the United States. Pain did not vary across age groups (P=0.21), and this pattern remained unchanged when accounting for cognitive performance, dementia, proxy responses, and residential care living status. Pain prevalence was higher in women and in older adults with obesity, musculoskeletal conditions, and depressive symptoms (P<0.001). The majority (74.9%) of older adults with pain endorsed multiple sites of pain. Several measures of physical capacity, including grip strength and lower-extremity physical performance, were associated with pain and multisite pain. For example, self-reported inability to walk 3 blocks was 72% higher in participants with than without pain (adjusted prevalence ratio 1.72 [95% confidence interval 1.56-1.90]). Participants with 1, 2, 3, and ⩾4 sites of pain had gait speeds that were 0.01, 0.03, 0.05, and 0.08 meters per second slower, respectively, than older adults without pain, adjusting for disease burden and other potential confounders (P<0.001). In summary, bothersome pain in the last month was reported by half of the older adult population of the United States in 2011 and was strongly associated with decreased physical function.
Background:
Pain is often inadequately evaluated and treated in sub-Saharan Africa (SSA).
Objective:
We sought to assess pain levels and pain treatment in 400 hospitalized patients at a national referral hospital in western Kenya, and to identify factors associated with pain and pain treatment.
Design:
Using face-validated Kiswahili versions of two single-item pain assessment tools, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), we determined patients' pain levels. Additional data collected included patient demographics, prescribed analgesics, and administered analgesics. We calculated mean pain ratings and pain management index (PMI) scores.
Results:
Averaged between the NRS and FPS-R, 80.5% of patients endorsed a nonzero level of pain and 30% of patients reported moderate to severe pain. Older patients, patients with HIV, and cancer patients had higher pain ratings. Sixty-six percent of patients had been prescribed analgesics at some point during their hospitalization, the majority of which were nonopioids. A majority of patients (66%) had undertreated pain (negative scores on the PMI).
Conclusion:
This study shows that hospitalized patients in Kenya are experiencing pain and that this pain is often undertreated.
Considerable evidence suggests regular physical activity can reduce chronic pain symptoms. Dysfunction of endogenous facilitatory and inhibitory systems has been implicated in multiple chronic pain conditions. However, few studies have investigated the relationship between levels of physical activity and descending pain modulatory function.
This study's purpose was to determine whether self-reported levels of physical activity in healthy adults predicted 1) pain sensitivity to heat and cold stimuli, 2) pain facilitatory function as tested by temporal summation of pain (TS), and 3) pain inhibitory function as tested by conditioned pain modulation (CPM) and offset analgesia.
Forty-eight healthy adults (age range 18-76) completed the International Physical Activity Questionnaire (IPAQ) and the following pain tests: heat pain thresholds (HPT), heat pain suprathresholds, cold pressor pain (CPP), temporal summation of heat pain, conditioned pain modulation, and offset analgesia. The IPAQ measured levels of walking, moderate, vigorous and total physical activity over the past seven days. Hierarchical linear regressions were conducted to determine the relationship between each pain test and self-reported levels of physical activity, while controlling for age, sex and psychological variables.
Self-reported total and vigorous physical activity predicted TS and CPM (p's <.05). Individuals who self-reported more vigorous and total physical activity exhibited reduced temporal summation of pain and greater CPM. The IPAQ measures did not predict any of the other pain measures.
Thus, these results suggest that healthy older and younger adults who self-report greater levels of vigorous and total physical activity exhibit enhanced descending pain modulatory function. Improved descending pain modulation may be a mechanism through which exercise reduces or prevents chronic pain symptoms.
Population-based studies have reported conflicting findings on the relationship between physical activity and pain, and most studies reporting a relationship are cross sectional. Temporal relationships are therefore difficult to infer and associations may be subject to confounding from a variety of other factors. The aim of the current study was to investigate the association between exercise and pain longitudinally and to use within subjects analyses to remove between subjects confounding.
In the population-based HUNT 3 study, participants reported both pain and level of exercise. A random sub-sample of 6419 participants was in addition invited to report their last week pain and exercise every three months over a 12 month period (five measurements in total). We used multilevel mixed effects linear regression analyses to prospectively estimate the association between regular levels of exercise (measured in HUNT 3) and subsequent longitudinal reporting of pain. We also estimated within-subjects associations (i.e. the variation in pain as a function of variation in exercise, over time, within individuals) to avoid confounding from between subject factors.
Among those invited to participate (N = 6419), 4219 subjects returned at least two questionnaires. Compared with subjects who reported no or light exercise, those who reported moderate levels of exercise or more at baseline, reported less pain in repeated measures over a 12 month period in analyses adjusted for age, sex,education and smoking. Adjusting for baseline level of pain distinctly attenuated the findings. Within subjects, an increase in exercise was accompanied by a concurrent reduction in intensity of pain. However, we found no indication that exercise level at one occasion was related to pain reporting three months later.
This longitudinal population-based study indicates that exercise is associated with lower level of pain and that this association is close in time.
Aim: To analyze the Short Physical Performance Battery's (SPPB) ability in screening for frailty in community-dwelling young elderly from cities with distinct socioeconomic conditions.
Methods: Elderly (65–74 years-of-age) from Canada (Saint Bruno; n = 60) and Brazil (Santa Cruz; n = 64) were evaluated with the SPPB to assess physical performance. Frailty was defined as the presence of ≥3 of the following criteria: weight loss, exhaustion, weakness, mobility limitation and low physical activity. Linear regression and receiver operating characteristics analyses were carried out.
Results: The SPPB correlated with frailty (R2 = 0.33), with better results for Saint Bruno. A cut-off of 9 in the SPPB had good sensitivity (92%) and specificity (80%) in discriminating frail from non-frail in Saint Bruno (area under the curve [AUC] = 0.81), but showed fair results in Santa Cruz (AUC = 0.61, sensitivity = 81% and specificity = 52%).
Conclusions: The SPPB better discriminated frailty in elderly with higher socioeconomic conditions (Saint Bruno). Geriatr Gerontol Int 2013; 13: 421–428.
Background:
Chronic pain is the leading cause of disability in developed countries. Prevalence is linked with socio-economic position (SEP), but little is known about the influence of SEP on disabling pain over the life course. We have investigated the influence of different life course trajectories of SEP on disabling pain ('pain interference') in postal surveys of adults aged ≥50 years sampled from the general population of adults registered with three UK general practices.
Methods:
Current pain interference was measured using the dichotomized 36-item Short-Form (SF-36) health survey. Three recalled SEP measures (age left school, longest job and current/most recent job) were dichotomized into low SEP (left school at or before minimum school leaving age; reported routine or manual occupations) and high SEP, from which eight life course SEP trajectories were constructed. Associations of (i) eight SEP trajectories and (ii) three individual SEP measures adjusted for each other, with pain interference, adjusted for potential confounders, were calculated using logistic regression.
Results:
A total of 2533 individuals provided data on all three SEP measures. A consistently low life course SEP trajectory was significantly associated with current pain interference compared with a high trajectory [odds ratio (OR) = 2.76, 95% confidence interval (CI): 2.19-3.47], even after adjustment for age and gender. Further adjustment reduced the association but it remained significant (OR = 2.04; 95% CI: 1.55-2.68). In the model with individual measures, low age left school (OR = 1.45; 95% CI: 1.15-1.82) and manual longest job (OR = 1.47; 95% CI: 1.13-1.91) were independently associated with pain interference.
Conclusions:
Our results highlight the potential for reducing chronic disabling pain in later life by addressing inequalities in both childhood education and adult occupational opportunities.
Objective:
To determine the psychometric properties and applicability of four pain scales in Chinese postoperative adults.
Design:
A prospective clinical study.
Setting:
A university-affiliated hospital.
Patients:
In total, 173 Chinese patients (age range 18-78 years) undergoing scheduled surgery.
Interventions:
Recalled pain and anticipated postoperative pain intensity were rated preoperatively with a visual analog scale (VAS), a numeric rating scale (NRS), a verbal descriptor scale (VDS), and the Faces Pain Scale Revised (FPS-R). From the day of surgery to the sixth postoperative day, patients were interviewed for the scores of current operative pain intensity and the worst, least, and average pain on that day. On the sixth postoperative day, retrospective ratings over the 7 days were also obtained and tool preferences were investigated.
Outcome measures:
Scale reliability was evaluated using intraclass correlation coefficients (ICCs). Scale validity was assessed by correlations between scales, analysis of variance with repeated measures, and the sensitivity of the scales to interventions. Chi-square tests were used to investigate if error rate and preference rate were related to gender, age, and educational level.
Results:
All four pain intensity scales had good reliability and validity when used with Chinese adults. The ICCs of the four scales across current, worst, least, and average pain on each postoperative day were consistently high (0.673-0.825), and all scales at each rating were strongly correlated (r = 0.71-0.99). Analysis of variance with repeated measures revealed significant decreases in scores associated with postoperative days, and all four scales were sensitive in evaluating analgesic efficacy. Both the VDS and the FPS-R had low error rates. Nearly half of the participants (48.1%) preferred the FPS-R, followed by the NRS (24.4%), the VDS (23.1%), and the VAS (4.4%); however, no significant differences were noted in terms of gender, age, and educational level.
Conclusions:
These findings demonstrate that although all four scales can be options for Chinese adults to report pain intensity, the FPS-R appears to be the best one. Providing tool options to address individual needs or preferences is suggested.
Objectives: To assess the validity and reliability of the Short Physical Performance Battery (SPPB) in adults 65 to 74 years old, capable in all basic activities of daily living (ADL), in Quebec and Brazil. Methods: Participants were recruited in St. Bruno (Quebec) by local advertisements (n = 60) and in Santa Cruz (Brazil) by random sampling (n = 64). The SPPB includes tests of gait, balance, and lower-limb strength. Disability status was categorized as intact mobility, limited mobility, and difficulty in any of ADL. Results: There was a graded decrease in mean SPPB scores with increasing limitation of lower limbs, disability, and poor health. Using the test–retest reliability the authors evaluated the intraclass correlation coefficient, which was high in both samples: .89 (95% CI: 0.83, 0.93) in St. Bruno and .83 in Santa Cruz (95% CI: 0.73, 0.89). Discussion: This study provides evidence for the validity and reliability of SPPB in diverse populations.
The goal of this study was to investigate whether certain metabolites, specific to neurons, glial cells, and the neuronal-glial neurotransmission system, in the primary somatosensory cortex (SSC), are altered and correlated with clinical characteristics of pain in patients with chronic low back pain (LBP). Eleven LBP patients and eleven age-matched healthy controls were included. N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), and glutamine/glutamate (Glx) were measured with proton magnetic resonance spectroscopy (¹H-MRS) in left and right SSC. Differences in metabolite concentrations relative to those of controls were evaluated as well as analyses of metabolite correlations within and between SSCs. Relationships between metabolite concentrations and pain characteristics were also evaluated. We found decreased NAA in the left SSC (P = 0.001) and decreased Cho (P = 0.04) along with lower correlations between all metabolites in right SSC (P = 0.007) in LBP compared to controls. In addition, we found higher and significant correlations between left and right mI (P < 0.001 in LBP vs P = 0.1 in controls) and between left mI and right Cho (P = 0.048 vs P = 0.6). Left and right NAA levels were negatively correlated with pain duration (P = 0.04 and P = 0.02 respectively) while right Glx was positively correlated with pain severity (P = 0.04). Our preliminary results demonstrated significant altered neuronal-glial interactions in SSC, with left neural alterations related to pain duration and right neuronal-glial alterations to pain severity. Thus, the ¹H-MRS approach proposed here can be used to quantify relevant cerebral metabolite changes in chronic pain, and consequently increase our knowledge of the factors leading from these changes to clinical outcomes.
Survival estimates help individualize goals of care for geriatric patients, but life tables fail to account for the great variability in survival. Physical performance measures, such as gait speed, might help account for variability, allowing clinicians to make more individualized estimates.
To evaluate the relationship between gait speed and survival.
Pooled analysis of 9 cohort studies (collected between 1986 and 2000), using individual data from 34,485 community-dwelling older adults aged 65 years or older with baseline gait speed data, followed up for 6 to 21 years. Participants were a mean (SD) age of 73.5 (5.9) years; 59.6%, women; and 79.8%, white; and had a mean (SD) gait speed of 0.92 (0.27) m/s.
Survival rates and life expectancy.
There were 17,528 deaths; the overall 5-year survival rate was 84.8% (confidence interval [CI], 79.6%-88.8%) and 10-year survival rate was 59.7% (95% CI, 46.5%-70.6%). Gait speed was associated with survival in all studies (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87-0.90; P < .001). Survival increased across the full range of gait speeds, with significant increments per 0.1 m/s. At age 75, predicted 10-year survival across the range of gait speeds ranged from 19% to 87% in men and from 35% to 91% in women. Predicted survival based on age, sex, and gait speed was as accurate as predicted based on age, sex, use of mobility aids, and self-reported function or as age, sex, chronic conditions, smoking history, blood pressure, body mass index, and hospitalization.
In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults.
To do a quantitative systematic review, including published and unpublished data, examining the associations between individual objective measures of physical capability (grip strength, walking speed, chair rising, and standing balance times) and mortality in community dwelling populations.
Systematic review and meta-analysis.
Relevant studies published by May 2009 identified through literature searches using Embase (from 1980) and Medline (from 1950) and manual searching of reference lists; unpublished results were obtained from study investigators.
Eligible observational studies were those done in community dwelling people of any age that examined the association of at least one of the specified measures of physical capability (grip strength, walking speed, chair rises, or standing balance) with mortality.
Effect estimates obtained were pooled by using random effects meta-analysis models with heterogeneity between studies investigated.
Although heterogeneity was detected, consistent evidence was found of associations between all four measures of physical capability and mortality; those people who performed less well in these tests were found to be at higher risk of all cause mortality. For example, the summary hazard ratio for mortality comparing the weakest with the strongest quarter of grip strength (14 studies, 53 476 participants) was 1.67 (95% confidence interval 1.45 to 1.93) after adjustment for age, sex, and body size (I(2)=84.0%, 95% confidence interval 74% to 90%; P from Q statistic <0.001). The summary hazard ratio for mortality comparing the slowest with the fastest quarter of walking speed (five studies, 14 692 participants) was 2.87 (2.22 to 3.72) (I(2)=25.2%, 0% to 70%; P=0.25) after similar adjustments. Whereas studies of the associations of walking speed, chair rising, and standing balance with mortality have only been done in older populations (average age over 70 years), the association of grip strength with mortality was also found in younger populations (five studies had an average age under 60 years).
Objective measures of physical capability are predictors of all cause mortality in older community dwelling populations. Such measures may therefore provide useful tools for identifying older people at higher risk of death.
Objective:
To validate a revision of the Mini Nutritional Assessment short-form (MNA(R)-SF) against the full MNA, a standard tool for nutritional evaluation.
Methods:
A literature search identified studies that used the MNA for nutritional screening in geriatric patients. The contacted authors submitted original datasets that were merged into a single database. Various combinations of the questions on the current MNA-SF were tested using this database through combination analysis and ROC based derivation of classification thresholds.
Results:
Twenty-seven datasets (n=6257 participants) were initially processed from which twelve were used in the current analysis on a sample of 2032 study participants (mean age 82.3y) with complete information on all MNA items. The original MNA-SF was a combination of six questions from the full MNA. A revised MNA-SF included calf circumference (CC) substituted for BMI performed equally well. A revised three-category scoring classification for this revised MNA-SF, using BMI and/or CC, had good sensitivity compared to the full MNA.
Conclusion:
The newly revised MNA-SF is a valid nutritional screening tool applicable to geriatric health care professionals with the option of using CC when BMI cannot be calculated. This revised MNA-SF increases the applicability of this rapid screening tool in clinical practice through the inclusion of a "malnourished" category.
Objective:
To evaluate whether interventions aimed at increasing adherence to therapeutic exercise increase adherence greater than a contextually equivalent control among older adults with chronic low back pain and/or hip/knee osteoarthritis.
Design:
A systematic review and meta-analysis.
Data sources:
Five databases (MEDLINE (PubMed), CINAHL, SportDISCUS (EBSCO), Embase (Ovid) and Cochrane Library) were searched until 1 August 2016.
Eligibility criteria for selecting studies:
Randomised controlled trials that isolated the effects of interventions aiming to improve adherence to therapeutic exercise among adults ≥45 years of age with chronic low back pain and/or hip/knee osteoarthritis were included.
Results:
Of 3899 studies identified, nine studies (1045 participants) were eligible. Four studies, evaluating strategies that aimed to increase motivation or using behavioural graded exercise, reported significantly better exercise adherence (d=0.26-1.23). In contrast, behavioural counselling, action coping plans and/or audio/video exercise cues did not improve adherence significantly. Meta-analysis using a random effects model with the two studies evaluating booster sessions with a physiotherapist for people with osteoarthritis revealed a small to medium significant pooled effect in favour of booster sessions (standardised mean difference (SMD) 0.39, 95% CI 0.05 to 0.72, z=2.26, p=0.02, I(2)=35%).
Conclusions:
Meta-analysis provides moderate-quality evidence that booster sessions with a physiotherapist assisted people with hip/knee osteoarthritis to better adhere to therapeutic exercise. Individual high-quality trials supported the use of motivational strategies in people with chronic low back pain and behavioural graded exercise in people with osteoarthritis to improve adherence to exercise.
The objective was to estimate the prevalence of chronic widespread pain (CWP) and compare the quality of life (QoL), cardiovascular risk factors, comorbidity, complexity, and health costs with the reference population.A multicenter case-control study was conducted at three primary care centers in Barcelona between January and December 2012: 3048 randomized patients were evaluated for CWP according to American College of Rheumatology definition. Questionnaires on pain, QoL, disability, fatigue, anxiety, depression, and sleep quality were administered. Cardiovascular risk and the Charlson index were calculated. We compared the complexity of cases and controls using Clinical Risk Groups, severity and annual direct and indirect healthcare costs.CWP criteria were found in 168 patients (92.3% female, prevalence 5.51% (95%CI: 4.75% - 6.38%)). CWP patients had worse QoL (34.2 vs 44.1, p<0.001), and greater disability (1.04 vs 0.35; p<0.001), anxiety (43.9% vs 13.3%; p<0.001), depression (27% vs 5.8%; p<0.001), sleep disturbances, obesity, sedentary lifestyle, high blood pressure, diabetes mellitus and number of cardiovascular events (13.1% vs 4.8%; p = 0.028) and higher rates of complexity, severity, hospitalization, and mortality. Costs were &OV0556; 3,751 per year in CWP patients vs. &OV0556; 1,397 in controls (p<0.001).In conclusion, the average CWP patient has a worse QoL and a greater burden of mental health disorders and cardiovascular risk. The average annual cost associated with CWP is nearly three times higher than that of patients without CWP, controlling for other clinical factors. These findings have implications for disease management and budgetary considerations.
This study estimates the percentage of health care expenditures in the non-institutionalized United States (U.S.) adult population associated with levels of physical activity inadequate to meet current guidelines. Leisure-time physical activity data from the National Health Interview Survey (2004–2010) were merged with health care expenditure data from the Medical Expenditure Panel Survey (2006–2011). Health care expenditures for inactive (i.e., no physical activity) and insufficiently active adults (i.e., some physical activity but not enough to meet guidelines) were compared with active adults (i.e., ≥ 150 minutes/week moderate-intensity equivalent activity) using an econometric model. Overall, 11.1% (95% CI: 7.3, 14.9) of aggregate health care expenditures were associated with inadequate physical activity. When adults with any reported difficulty walking due to a health problem were excluded, 8.7% (95% CI: 5.2, 12.3) of aggregate health care expenditures were associated with inadequate physical activity. Increasing adults’ physical activity to meet guidelines may reduce U.S. health care expenditures.
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A cross-sectional epidemiologic survey was performed to determine the prevalence of chronic pain (CP) and to identify associated factors in a random sample of persons 15 years or older from a segment of the population of São Paulo City, Brazil. A total of 1,108 eligible participants were randomly selected, and face-to-face interviews were performed with 826 individuals (74.5%) between December 2011 and February 2012. Chronic Pain Grade, Hospital Anxiety and Depression Scale, and EuroQol-5D were used to verify pain characteristics and the associated signs of psychological distress. A prevalence of 42% (95% confidence interval, 38.6-45.4) was observed for CP, and the participants with CP had an average pain intensity of 5.9 (standard deviation = 1.9) and a pain-related disability of 4.1 (standard deviation = 3.2) on a 0 to 10 scale. Persistent pain was present in 68.6% of those with CP, and 32.8% of the population sample had high-intensity or high-interference pain (Chronic Pain Grade II, III, and IV). Quality of life was significantly worse among the CP individuals. The following factors were independently associated with CP: female gender, age 30 years or older, ≤ 4 years of education, symptoms consistent with anxiety, and intense physical strain. Indicators of pain severity increased with pain grades.
Perspective:
CP is highly prevalent in the city of São Paulo and has a considerable impact on health-related quality of life. Demographic, socioeconomic, and psychological factors are independently associated with this condition.
Objectives
To determine the effects of chronic pain on the development of disability and decline in physical performance over time in older adults.DesignLongitudinal cohort study with 18 months of follow-up.SettingUrban and suburban communities.ParticipantsCommunity-dwelling older adults aged 65 and older (N = 634).MeasurementsChronic 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.ResultsAlmost 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.
Physical deconditioning in combination with societal and emotional factors has been hypothesized to compromise complete recovery from low back pain (LBP). However, there is a lack of longitudinal studies designed to specifically investigate physical activity as an independent prognostic factor. We conducted a prognostic study to investigate whether levels of leisure time physical activity are independently associated with clinical outcomes in people seeking care for chronic and persistent LBP.
A total of 815 consecutive patients presenting with LBP to an outpatient spine centre in secondary care were recruited. Separate multivariate linear regression analyses were performed to investigate whether levels of leisure time physical activity (i.e., sedentary, light and moderate-to-vigorous leisure time physical activity levels) predict pain and disability at 12-month follow-up, after adjusting for age, pain, episode duration, disability, neurological symptoms, depression and fear of movement.
Final models showed evidence of an association between baseline physical activity and 12-month outcomes (p < 0.001). In both models, the moderate-to-vigorous physical activity group reported less pain and disability compared with the sedentary group.
Our findings suggest that physical activity levels may have a role in the prognosis of LBP. Specific domains of physical activity warrant further investigation to better understand this association.
The comorbidity of pain and depression has been well established in the literature and is associated with a greater burden to the individual and society than either condition alone. The relationship between pain and depression is quite complex and multiple factors must be considered when trying to disentangle the pain-depression link including shared neurobiology, precipitating environmental factors and cognitive influences. This article aims to provide an overview of the leading neurobiological and psychosocial theories that have advanced our understanding of the link between pain and depression. To this end we describe the shared neurobiological mechanisms in the brain thought to explain the overlap and consider psychological processes and how they inform a cognitive behavioral model. The article also provides an overview of the evidence based treatment for comorbid pain and depression.
Recent years have witnessed substantially increased research regarding sex differences in pain. The expansive body of literature in this area clearly suggests that men and women differ in their responses to pain, with increased pain sensitivity and risk for clinical pain commonly being observed among women. Also, differences in responsivity to pharmacological and non-pharmacological pain interventions have been observed; however, these effects are not always consistent and appear dependent on treatment type and characteristics of both the pain and the provider. Although the specific aetiological basis underlying these sex differences is unknown, it seems inevitable that multiple biological and psychosocial processes are contributing factors. For instance, emerging evidence suggests that genotype and endogenous opioid functioning play a causal role in these disparities, and considerable literature implicates sex hormones as factors influencing pain sensitivity. However, the specific modulatory effect of sex hormones on pain among men and women requires further exploration. Psychosocial processes such as pain coping and early-life exposure to stress may also explain sex differences in pain, in addition to stereotypical gender roles that may contribute to differences in pain expression. Therefore, this review will provide a brief overview of the extant literature examining sex-related differences in clinical and experimental pain, and highlights several biopsychosocial mechanisms implicated in these male-female differences. The future directions of this field of research are discussed with an emphasis aimed towards further elucidation of mechanisms which may inform future efforts to develop sex-specific treatments.
Objective:
To compare the overall levels of physical activity of older adults with chronic musculoskeletal pain and asymptomatic controls.
Review methods:
A systematic review of the literature was conducted using a Cochrane methodology and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Major electronic databases were searched from inception until December 2012, including the Cochrane Library, CINAHL, EBSCO, EMBASE, Medline, PubMed, PsycINFO, and the international prospective register of systematic reviews. In addition, citation chasing was undertaken, and key authors were contacted. Eligibility criteria were established around participants used and outcome measures focusing on daily physical activity. A meta-analysis was conducted on appropriate studies.
Results:
Eight studies met the eligibility criteria, four of these reported a statistically lower level of physical activity in the older adult sampl e with chronic pain compared with the asymptomatic group. It was possible to perform a non-heterogeneous meta-analysis on five studies. This established that 1,159 older adults with chronic pain had a significantly lower level of physical activity (-0.20, confidence interval 95% = -0.34 to -0.06, p = 0.004) compared with 576 without chronic pain.
Conclusion:
Older adults with chronic pain appear to be less active than asymptomatic controls. Although this difference was small, it is likely to be clinically meaningful. It is imperative that clinicians encourage older people with chronic pain to remain active as physical activity is a central non-pharmacological strategy in the management of chronic pain and is integral for healthy aging. Future research should prioritize the use of objective measurement of physical activity.
Exercise is recommended as a first-line conservative intervention approach for osteoarthritis (OA). A wide range of exercise programs are available and scientific evidence is necessary for choosing the optimal strategy of treatment for each patient. The purpose of this review is to discuss the effectiveness of different types of exercise programs for OA based on trials, systematic reviews, and meta-analyses in the literature. Publications from January 1997 to July 2012 were searched in 4 electronic databases using the terms osteoarthritis, exercise, exercise program, effectiveness, and treatment outcome. Strong evidence supports that aerobic and strengthening exercise programs, both land- and water-based, are beneficial for improving pain and physical function in adults with mild-to-moderate knee and hip OA. Areas that require further research include examination of the long-term effects of exercise programs for OA, balance training for OA, exercise programs for severe OA, the effect of exercise programs on progression of OA, the effectiveness of exercise for joint sites other than the knee or hip, and the effectiveness of exercise for OA by such factors as age, sex, and obesity. Efforts to improve adherence to evidence-based exercise programs for OA and to promote the dissemination and implementation of these programs are crucial.
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A cross-sectional nationwide epidemiological study was performed in a random sample of the Portuguese adult population, aiming to describe the prevalence and impact of chronic pain (CP). The 5,094 participants were selected by random digit dialing, between January 2007 and March 2008, and estimates were adequately weighted for the population. Prevalence of CP was 36.7% (95% confidence interval [CI] [35.3-38.2]), based on the definition of the International Association for the Study of Pain. Recurrent or continuous pain was present in 85% of those with CP, and moderate-to-severe intensity and disability were present in 68 and 35%, respectively. Highest CP prevalence was observed among the elderly, retired, unemployed, and less educated. Highest disability was found in relation with family/home responsibilities, recreational activities, occupation/work, and sleep/rest; 13% reported a diagnosis of depression and 49% reported interference in their job. The main factors associated with disability were sex, pain intensity, and depression or depressive symptoms. CP is highly prevalent, causes high personal and social burden, and affects particularly the most vulnerable subgroups. Portugal, depending on CP definition, could be placed in the lower prevalence group in Europe. Improvement in pain intensity management and special attention to affective components of CP are recommended.
Perspective:
In this cross-sectional nationwide epidemiological study, we showed that chronic pain is a significant problem that is present in 37% of the Portuguese adult general population, is associated with high personal, family, and social burden, and affects in particular the most vulnerable subgroups of the population.
: A key component of successful aging is the ability to independently perform instrumental activities of daily living (IADL). We examined the ability to perform multiple IADL tasks in relation to mild cognitive impairment (MCI) defined on purely neuropsychological grounds.
: Cross-sectional study.
: Population-based cohort in southwestern Pennsylvania.
: One thousand seven hundred thirty-seven community-dwelling adults age 65 years and older.
: Classification of MCI based on performance with reference to norms in the cognitive domains of memory, language, attention, executive, and visuospatial functions. The ability to perform seven IADL tasks (traveling, shopping, preparing meals, doing housework, taking medications, handling personal finances, and using the telephone) as assessed by the Older Americans Resources and Services scale.
: Those with cognitively defined MCI were more likely to be dependent in at least one IADL task, as well as in each individual IADL task, than cognitively normal participants. Better memory and executive functioning were associated with lower odds of IADL dependence in MCI. Across the subtypes of MCI, those with the multiple-domain amnestic subtype were most likely to be dependent in all IADL tasks, with better executive functioning associated with lower risk of dependence in select IADL tasks in this group.
: Mild impairment in cognition is associated with difficulty performing IADL tasks at the population level. Understanding these associations may help improve prediction of the outcomes of MCI. It may also allow appropriate targeting of cognitive interventions in MCI to potentially help preserve functional independence.
Sleep of good quantity and quality is considered a biologically important resource necessary to maintain homeostasis of pain‐regulatory processes. To assess the role of chronic sleep disturbances in pain processing, we conducted laboratory pain testing in subjects with primary insomnia.
Seventeen participants with primary insomnia (mean ± SEM 22.6 ± 0.9 yrs, 11 women) were individually matched with 17 healthy participants. All participants wore an actigraph device over a 2‐week period and completed daily sleep and pain diaries. Laboratory pain testing was conducted in a controlled environment and included (1) warmth detection threshold testing, (2) pain sensitivity testing (threshold detection for heat and pressure pain), and (3) tests to access pain modulatory mechanisms (pain facilitation and inhibition).
Primary insomnia subjects reported experiencing spontaneous pain on twice as many days as healthy controls during the at‐home recording phase ( p < 0.05). During laboratory testing, primary insomnia subjects had lower pain thresholds than healthy controls ( p < 0.05 for heat pain detection threshold, p < 0.08 for pressure pain detection threshold). Unexpectedly, pain facilitation, as assessed with temporal summation of pain responses, was reduced in primary insomnia compared to healthy controls ( p < 0.05). Pain inhibition, as assessed with the diffuse noxious inhibitory control paradigm ( DNIC ), was attenuated in insomnia subjects when compared to controls ( p < 0.05).
Based on these findings, we propose that pain‐inhibitory circuits in patients with insomnia are in a state of constant activation to compensate for ongoing subclinical pain. This constant activation ultimately may result in a ceiling effect of pain‐inhibitory efforts, as indicated by the inability of the system to adequately function during challenge.
We investigated the association of chronic pain with physical and mental comorbidity in the New Zealand population by measuring chronic pain status separate from comorbid conditions. Models of allostatic load provided a conceptual basis for considering multi-morbidity as accumulated comorbid load and for using both discrete conditions and cumulative measures in analyses. The nationally representative cross-sectional survey data included self-reported doctor-diagnosed chronic physical and mental health conditions, Kessler 10-item scale scores, an independent measure of chronic pain, and sociodemographic characteristics. The population prevalence of chronic pain is 16.9%, and a quarter (26%) of the population report 2 or more comorbid physical conditions statistically associated with chronic pain (unadjusted P<0.01). Results indicate that accumulated comorbid load is independently associated with chronic pain. Six physical conditions independently associated with chronic pain (adjusted odds range from 1.4 to 3.9) increase the risk of chronic pain in an additive manner, and residual accumulated load further increases risk for 2 or more conditions (adjusted odds 1.6). Anxiety/depression interacts synergistically with arthritis and neck/back disorders to increase the odds of reporting chronic pain beyond an additive model. This synergistic effect is not apparent for other conditions or for additional comorbid load. Results imply that measurement of chronic pain independent of comorbid conditions and adjustment for comorbid conditions is important for more accurate prevalence estimates and understanding relationships between conditions. Future epidemiological research might usefully incorporate independent measurement of chronic pain alongside adjustment for specific physical and mental health conditions as well as accumulated comorbid load.
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The primary symptom of fibromyalgia (FM) is chronic, widespread pain; however, patients report additional symptoms including decreased concentration and memory. Performance-based deficits are seen mainly in tests of working memory and executive function. Neural correlates of executive function were investigated in 18 FM patients and 14 age-matched healthy controls during a simple Go/No-Go task (response inhibition) while they underwent functional magnetic resonance imaging (fMRI). Performance was not different between FM and healthy control, in either reaction time or accuracy. However, fMRI revealed that FM patients had lower activation in the right premotor cortex, supplementary motor area, midcingulate cortex, putamen and, after controlling for anxiety, in the right insular cortex and right inferior frontal gyrus. A hyperactivation in FM patients was seen in the right inferior temporal gyrus/fusiform gyrus. Despite the same reaction times and accuracy, FM patients show less brain activation in cortical structures in the inhibition network (specifically in areas involved in response selection/motor preparation) and the attention network along with increased activation in brain areas not normally part of the inhibition network. We hypothesize that response inhibition and pain perception may rely on partially overlapping networks, and that in chronic pain patients, resources taken up by pain processing may not be available for executive functioning tasks such as response inhibition. Compensatory cortical plasticity may be required to achieve performance on a par with control groups.
Perspective:
Neural activation (fMRI) during response inhibition was measured in fibromyalgia patients and controls. FM patients show lower activation in the inhibition and attention networks and increased activation in other areas. Inhibition and pain perception may use overlapping networks: resources taken up by pain processing may be unavailable for other processes.
Individuals reporting chronic, nonmalignant pain for at least 6 months (N=114) were randomly assigned to 8 weekly group sessions of acceptance and commitment therapy (ACT) or cognitive-behavioral therapy (CBT) after a 4-6 week pretreatment period and were assessed after treatment and at 6-month follow-up. The protocols were designed for use in a primary care rather than specialty pain clinic setting. All participants remained stable on other pain and mood treatments over the course of the intervention. ACT participants improved on pain interference, depression, and pain-related anxiety; there were no significant differences in improvement between the treatment conditions on any outcome variables. Although there were no differences in attrition between the groups, ACT participants who completed treatment reported significantly higher levels of satisfaction than did CBT participants. These findings suggest that ACT is an effective and acceptable adjunct intervention for patients with chronic pain.
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Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and co-occur 30 to 50% of the time. However, their reciprocal relationship and potentially causative effects on one another have been inadequately studied. Longitudinal data analysis involving 500 primary care patients with persistent back, hip, or knee pain were enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. Half of the participants had comorbid depression and were randomized to a stepped care intervention (n = 123) or treatment as usual (n = 127). Another 250 nondepressed patients with similar pain were followed in a parallel cohort. Outcomes were assessed at baseline, 3, 6, and 12 months. Mixed effects model repeated measures (MMRM) multivariable analyses were conducted to determine if change in pain severity predicted subsequent depression severity, and vice versa. Change in pain was a strong predictor of subsequent depression severity (t-value = 6.63, P < .0001). Likewise, change in depression severity was an equally strong predictor of subsequent pain severity (t-value = 7.28, P < .0001). Results from the full cohort were similar in the clinical trial subgroup. In summary, pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months.
Perspective:
This study strengthens the evidence for a bidirectional and potentially causative influence of pain and depression on one another. A change in severity of either symptom predicts subsequent severity of the other symptom. Thus, recognition and management of both conditions may be warranted, particularly when treatment focused on 1 condition is not leading to an optimal response.
The evidence for an association between leisure-time physical activity and prevalence of pain is insufficient. This study investigated associations between frequency, duration, and intensity of recreational exercise and chronic pain in a cross-sectional survey of the adult population of a Norwegian county (the Nord-Trøndelag Health Study; HUNT 3). Of the 94,194 invited to participate, complete data were obtained from 46,533 participants. Separate analyses were performed for the working-age population (20-64 years) and the older population (65 years or more). When defined as pain lasting longer than 6 months, and of at least moderate intensity during the past month, the overall prevalence of chronic pain was 29%. We found that increased frequency, duration, and intensity of exercise were associated with less chronic pain in analyses adjusted for age, education, and smoking. For those aged 20-64 years, the prevalence of chronic pain was 10-12% lower for those exercising 1-3 times a week for at least 30 minutes duration or of moderate intensity, relative to those not exercising. Dependent on the load of exercise, the prevalence of chronic pain was 21-38% lower among older women who exercised, relative to those not exercising. Similar, but somewhat weaker, associations were seen for older men. This study shows consistent and linear associations between frequency, duration, and intensity of recreational exercise and chronic pain for the older population, and associations without an apparent linear shape for the working-age population.
A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients.
Research, guidelines, and experts in the field suggest that persons with cognitive impairment report pain less often and at a lower intensity than those without cognitive impairment. However, this presupposition is derived from research with important limitations, namely, inadequate power and lack of multivariate adjustment.
We conducted a cross-sectional analysis of the Canadian Study of Health and Aging to evaluate the relationship between cognitive status and pain self-report.
Cognitive status was assessed using the Modified Mini-Mental State Examination. Pain was assessed using a 5-point verbal descriptor scale. For analysis, responses were dichotomized into "no pain" vs. "any pain" and "pain at a moderate or higher intensity" vs. "pain not at a moderate or higher intensity." Additional predictors included demographics, physical function, depression, and comorbidity.
Of 5,703 eligible participants, 306 (5.4%) did not meet inclusion criteria, leaving a total of 5,397, of whom 876 (16.2%) were cognitively impaired. In the unadjusted analysis, significantly more cognitively intact (n=2,541; 56.2%) than cognitively impaired (n=456; 52.1%; P=0.03) participants reported noncancer pain. There was no significant difference in the proportion of cognitively intact (n=1,623; 35.9%) and impaired (n=329; 37.6%; P=0.36) participants who reported pain to be at moderate or higher intensity. In multivariate analyses, cognitively impaired participants did not have lower odds of reporting any noncancer pain (odds ratio [OR]=0.83 [0.68-1.01]; P=0.07) or pain at a moderate or higher intensity (OR=0.95 [0.78-1.16]; P=0.62).
Non-cancer pain was equally prevalent in people with and without cognitive impairment, which contrasts with the currently held opinion that cognitively impaired persons report noncancer pain less often and at a lower intensity.