Persistence of Musculoskeletal Pain in Older Adults
Persistence of Musculoskeletal Pain in Older Adults
Objectives To characterize longitudinal patterns of musculoskeletal pain in a community sample of older adults over a 6-year period and to identify factors associated with persistence of pain.
Design Secondary analysis of the Cardiovascular Health Study.
Setting Community-based cohort drawn from four U.S. counties.
Participants Five thousand ninety-three men and women aged 65 and older.
Measurements Over a 6-year period, pain was assessed each year using a single question about the presence of pain in any bones or joints during the last year. If affirmative, participants were queried about pain in seven locations (hands, shoulders, neck, back, hips, knees, feet). Participants were categorized according to the percentage of time that pain was present and according to the intermittent or chronic pattern of pain. Factors associated with persistent pain during five remaining years of the study were identified.
Results Over 6 years, 32% of participants reported pain for three or more consecutive years, and 32% reported pain intermittently. Of those who reported pain the first year, 54% were pain free at least once during the follow-up period. Most of the pain at specific body locations was intermittent. Factors associated with remission of pain over 5 years included older age, male sex, better self-rated health, not being obese, taking fewer medications, and having fewer depressive symptoms. Approximately half of those with pain reported fewer pain locations the following year.
Conclusion Musculoskeletal pain in older adults, despite high prevalence, is often intermittent. The findings refute the notion that pain is an inevitable, unremitting, or progressive consequence of aging.
The high prevalence of bone and joint pain in older adults has contributed to the assumption that it may be an unfortunate dividend of growing older. Many older adults identify joint pain as a normal part of life, with such statements as, "That's how you know you're alive… you ache. Providers may be complicit, suggesting that people get used to joint pain because "it's only going to get worse. The expectation that aging adults accumulate "wear and tear" mechanical injury, with no potential for effective remedy except joint replacement, reinforces the expectation that, as people age, they will experience pain.
In a recent study of 502 British adults aged 50 and older with musculoskeletal pain, 82% believed that receiving information about the prognosis of their pain was important, but only 33% reported discussing prognosis with their general practitioner. These individuals reported that a prognosis could help them to plan for future activity and to know for the sake of knowing. They felt discouraged from seeking prognostic information because they believed that progression of pain was inevitable, that pain could not be accurately predicted, and that nothing could be done to help them.
Previous research has not characterized the longitudinal course or predictors of persistent musculoskeletal pain in older adults well. Early studies focused more on radiographic findings than pain. Community-based studies have mainly measured the prevalence of musculoskeletal pain at a single time point or using a single follow-up, rather than its longitudinal course. Studies that monitor outcomes over time have generally recruited participants from clinical rather than community settings, generating conflicting results about the effects of age and other factors on prognosis. The current study was designed to characterize the frequency, longitudinal course, and predictors of persistence of musculoskeletal pain in a community cohort of older adults.
Abstract and Introduction
Abstract
Objectives To characterize longitudinal patterns of musculoskeletal pain in a community sample of older adults over a 6-year period and to identify factors associated with persistence of pain.
Design Secondary analysis of the Cardiovascular Health Study.
Setting Community-based cohort drawn from four U.S. counties.
Participants Five thousand ninety-three men and women aged 65 and older.
Measurements Over a 6-year period, pain was assessed each year using a single question about the presence of pain in any bones or joints during the last year. If affirmative, participants were queried about pain in seven locations (hands, shoulders, neck, back, hips, knees, feet). Participants were categorized according to the percentage of time that pain was present and according to the intermittent or chronic pattern of pain. Factors associated with persistent pain during five remaining years of the study were identified.
Results Over 6 years, 32% of participants reported pain for three or more consecutive years, and 32% reported pain intermittently. Of those who reported pain the first year, 54% were pain free at least once during the follow-up period. Most of the pain at specific body locations was intermittent. Factors associated with remission of pain over 5 years included older age, male sex, better self-rated health, not being obese, taking fewer medications, and having fewer depressive symptoms. Approximately half of those with pain reported fewer pain locations the following year.
Conclusion Musculoskeletal pain in older adults, despite high prevalence, is often intermittent. The findings refute the notion that pain is an inevitable, unremitting, or progressive consequence of aging.
Introduction
The high prevalence of bone and joint pain in older adults has contributed to the assumption that it may be an unfortunate dividend of growing older. Many older adults identify joint pain as a normal part of life, with such statements as, "That's how you know you're alive… you ache. Providers may be complicit, suggesting that people get used to joint pain because "it's only going to get worse. The expectation that aging adults accumulate "wear and tear" mechanical injury, with no potential for effective remedy except joint replacement, reinforces the expectation that, as people age, they will experience pain.
In a recent study of 502 British adults aged 50 and older with musculoskeletal pain, 82% believed that receiving information about the prognosis of their pain was important, but only 33% reported discussing prognosis with their general practitioner. These individuals reported that a prognosis could help them to plan for future activity and to know for the sake of knowing. They felt discouraged from seeking prognostic information because they believed that progression of pain was inevitable, that pain could not be accurately predicted, and that nothing could be done to help them.
Previous research has not characterized the longitudinal course or predictors of persistent musculoskeletal pain in older adults well. Early studies focused more on radiographic findings than pain. Community-based studies have mainly measured the prevalence of musculoskeletal pain at a single time point or using a single follow-up, rather than its longitudinal course. Studies that monitor outcomes over time have generally recruited participants from clinical rather than community settings, generating conflicting results about the effects of age and other factors on prognosis. The current study was designed to characterize the frequency, longitudinal course, and predictors of persistence of musculoskeletal pain in a community cohort of older adults.
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