The effect of age on the onset of pain interference in a general population of older adults: Prospective findings from the North Staffordshire Osteoarthritis Project (NorStOP)
Primary Care Musculoskeletal Research Centre, Primary Care Sciences, Keele University, Staffordshire ST5 5BG, UK. Pain
(Impact Factor: 5.21).
06/2007; 129(1-2):21-7. DOI: 10.1016/j.pain.2006.09.027
Pain that interferes with daily life appears to be strongly age-related in cross-sectional studies, although the nature of this relationship over time has not been established. We have investigated the onset and persistence of pain and pain interference over a 3-year period to determine their association with age in older people. A 3-year follow-up postal survey was conducted of adults aged 50 years and over (n=5366) who had previously been recruited as part of the North Staffordshire Osteoarthritis Project. Four thousand two-hundred and thirty-four completed questionnaires were received (adjusted response 84.7%). The occurrence of pain interference at 3 years was 19.7% in persons free of such pain at baseline, higher in females than males (6.0% difference; 95% CI: 2.6%, 9.3%), and showed a clear age-related trend with a more than twofold increase from 50 to 59 years (16.0%) to the 80+ years (35%). Any pain at follow-up was reported by 48% of those pain-free at recruitment, and this figure was similar for males and females, and across 10-year age-groups. Persistence of pain interference (72.1%) at 3 years was high. In adults aged 50 years and over, the onset of pain that interferes with life shows a clear gender difference and a consistent rise with age into the oldest age-group. This was in strong contrast to the onset of pain which showed no gender or age-related trends. The implications for public health, as for the treatment of the individual, are twofold, relating to efforts to prevent disabling pain from occurring and to understand the factors that accelerate the impact which pain has on everyday life when people reach the oldest ages.
Available from: Paul Campbell
- "Concordance between partners in osteoarthritis consultations were shown to be influenced by adjustment for participant age, with age explaining most of the association found. This finding fits with evidence that age is a significant risk factor for osteoarthritis conditions, and this was the single shared factor that explained the concordance effect (Felson et al., 2000; Thomas et al., 2007). However, the results show partner concordance in shoulder consultations was still significant after adjustment for all influences. "
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ABSTRACT: Musculoskeletal pain conditions are common and create substantial burden for the individual and society. While research has shown concordance between couples for risk of some diseases, e.g. heart disease or diabetes, little information is available on such effects for musculoskeletal pain conditions. Our aims were to investigate the presence of concordance between couples for consultations about pain, and to examine theoretical influences on such concordance.
This was a 1-year cross-sectional study of musculoskeletal pain consultations in a UK primary care database. In total 27,014 patients (13,507 couples) aged between 30 and 74 years were included. The main outcome measure was the presence of a musculoskeletal morbidity read code indicating a consultation for musculoskeletal conditions (any, back, neck, knee, shoulder, foot, osteoarthritis). Logistic regression was used to test associations with odds ratios (OR) and 95% confidence intervals (95% CI).
Patients whose partner had a musculoskeletal pain consultation were also more likely to consult for a musculoskeletal condition (OR 1.22, 95% CI 1.12-1.32). This association was found to be strongest for shoulder disorders (OR 1.91, 95% CI 1.06-3.47). No significant associations were found for other pain conditions.
Results show that partner concordance is present for consultations for some musculoskeletal conditions but not others. Possible explanations for concordance include the shared health behaviours between couples leading to potential heightened awareness of symptoms. Given the high prevalence of musculoskeletal pain within populations, it may be worth considering further the mechanisms that explain partner concordance.
© 2015 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®
Available from: Alison Kate Lillie
- "A modified PICO search  was used to identify information regarding musculoskeletal pain at the end of life. No comparison group was included as a scoping search had shown that there was limited literature available and we therefore planned to keep the search parameters as broad as possible. "
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ABSTRACT: Pain is an important issue in end of life care. Although musculoskeletal pain is common in older adults, it is rarely associated with the cause of death and may be overlooked as death approaches. Hence a major target for improving quality of life may be being missed.
To systematically search and critically review the literature on musculoskeletal pain at the end of lifeAmed, Cinahl, Internurse, Medline, Psych Info, Web of Knowledge and Cochrane review databases were searched for relevant research up to September 2012. The search strategy combined key words expanding the terms 'palliative' for population, 'musculoskeletal' for exposure, and 'pain' for outcome. Predefined inclusion and exclusion criteria were applied.
Five relevant papers and one letter to the editor were found, including case studies and epidemiological research. Current evidence suggests musculoskeletal pain is common in older adults at the end of life and that it can have a substantial impact on individual experience. No information about community based treatment of musculoskeletal pain at the end of life was found.
Priorities for future research include high quality epidemiological studies to establish the prevalence, natural history, impact, assessment, patient priorities and outcomes associated with musculoskeletal pain in the end of life period, and intervention research that provides an evidence base for treatment.
Available from: Andrew Moore
- "For those shading in at least one area of pain on the manikin, the presence of interfering pain was assessed using one item from the general health status measure, the SF-36: 'During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework )?' (Ware and Sherbourne, 1992). Respondents answering 'moderately', 'quite a bit' or 'extremely' on the five-category response scale were defined as having pain that interfered with their lives (Blyth et al., 2001; Thomas et al., 2004a, 2007; Jordan et al., 2008). This item relates to any pain, is not site specific and does not directly ask about areas shaded on the manikin. "
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ABSTRACT: Reporting of pain that does not interfere with life is common in the older population but little is known about people with such long-term non-interfering pain.
To assess whether non-interfering pain can be a long-term state, and to compare this group with those who continuously report no pain, and with those with chronic pain that interferes with life.
This was a prospective general population cohort study set within the North Staffordshire Osteoarthritis Project (NorStOP). People aged 50 plus were sent baseline, 3-year and 6-year questionnaires. Those who reported the same pain status (no pain, non-interfering pain, interfering pain) at each time point were compared on pain intensity, widespread pain and medication, and on sociodemographic and co-morbid characteristics at 6 years.
Forty percent of responders reported the same pain status at each time point; 12% reported long-term non-interfering pain. Fifty-nine percent of those with non-interfering pain reported at least one site of high pain intensity, 33% reported widespread pain, and 90% had used pain medication in the past 4 weeks. This group was similar to the no-pain group but distinct on sociodemographic and co-morbid measures from those with pain that interfered.
Long-term non-interfering pain is common, but despite often suffering from high pain intensity and widespread pain, those within this group seem to be able to control their pain without allowing it to affect their everyday lives. Future work is needed to assess how people with long-term pain ensure it does not cause interference with life.
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