Musculoskeletal pain and use of analgesics in relation to mobility limitation among community-dwelling persons aged 75 years and older

Underserved older adults' treatment preferences for a mind-body activity program for chronic pain delivered via shared medical visits in a community clinic

Older adults with chronic pain from underserved communities need evidence-based pain management programs. To meet this need, we interviewed patients and staff from an underserved community clinic to identify their treatment preferences and barriers and facilitators to participating in a mind-body activity program. We conducted nine qualitative interviews (two staff; seven patients) and six focus groups (three staff groups; three patient groups), transcribed them verbatim and then used inductive-deductive thematic analysis guided by two pre-specified superordinate domains: (1) treatment preferences and (2) barriers and facilitators to participation. Participants recommended flexible, group participation options (in person, remote) with a credible leader and with multi-cultural considerations. They generally reacted positively to the proposed content. Barriers included logistical barriers (e.g. transportation, finances), weather, and skepticism about novel treatments; facilitators centered on expanding access and increasing sense of community. Our findings highlight important considerations to facilitate the uptake of mind-body activity programs for underserved older adults with chronic pain.

Promoting musculoskeletal health and preventing ill health

Musculoskeletal conditions are highly prevalent among older adults and can have a significant impact on their quality of life. Musculoskeletal health is an important component of maintaining well-being and independence. A proactive approach is required, with nurses implementing strategies such as healthy diets and physical exercise that will support optimal health. This article considers the importance of musculoskeletal health, examines the risk factors for a decline in musculoskeletal health, and explores approaches that can improve outcomes and promote healthy ageing.

Effects of the WHO analgesic ladder on pain severity, pain interference, and blood pressure control in hypertensive patients with chronic musculoskeletal pain: a cross-sectional study

AIM

This study aimed to investigate the effects of pain management according to the World Health Organization (WHO) analgesic ladder on pain severity, pain interference, and blood pressure (BP) in treated hypertensive patients with chronic musculoskeletal pain.

BACKGROUND

Pain management can affect BP control owing to the proposed mechanism by which persistent pain contributes to increased BP. However, there are inadequate studies investigating the benefit of pain management in controlling both pain and BP in hypertensive patients who have chronic pain.

METHODS

In this cross-sectional study, demographic data and pain characteristics (resting pain score on the numerical pain rating scale, pain severity, and pain interference subscale of the Brief Pain Inventory) were collected via face-to-face interviews. BP was measured thrice on the same day. Data on pain medications taken in the previous 1 month were retrieved from the medical records. Participants were categorized into three groups following pain management patterns according to the WHO analgesic ladder: no, partial, and complete treatment. Multivariate logistic regression analysis (MLRA) was used to analyse the association between the variables and uncontrolled BP.

FINDINGS

Among 210 participants, the mean (standard deviation) age was 68 (15.5) years, and 60.47% had uncontrolled BP. The resting pain score, pain severity, and pain interference subscale scores of the complete treatment group were significantly lower than that of the partial treatment group (P = 0.036, 0.026, and 0.044, respectively). The MLRA revealed that pain management patterns were associated with uncontrolled BP (adjusted odds ratio [AOR]: 6.75; 95% confidence interval [CI]: 2.71-16.78; P < 0.001) and resting pain scores (AOR: 1.17; 95% CI: 1.04-1.38; P = 0.048). Our findings suggest that pain management patterns adhering to the WHO analgesic ladder can reduce pain severity and pain interference and also control BP in hypertensive patients with chronic musculoskeletal pain.

Patient and staff perspectives on pain treatment experiences in a community clinic serving under-resourced older adults

AIMS

Chronic pain affects up to 37.8% of older adults with higher prevalence among those in under-resourced communities. While there are many treatments for chronic pain, there are complexities to treating under-resourced older adults in community clinics, including multimorbidity, barriers to treatment access, and varying degrees of openness to different treatment approaches. Understanding patient and clinic staff perceptions of treatment options for chronic pain is critical for implementing treatment approaches that will work sustainably in the community. This study aimed to understand clinic staff and patients' perspectives on chronic pain treatment experiences.

METHODS

Focus groups and individual interviews were analyzed using a hybrid inductive-deductive approach.

RESULTS

Themes are: (1) Limited patient and clinic resources and availability affecting pain treatment experiences (e.g., copays, transportation challenges, and conflicting responsibilities), (2) Discrepancies in patient and staff approaches to treatment and the importance of trialing different pain management techniques to alleviate pain (e.g., trialing multiple treatments with varied success), and (3) Conflict between patients' desire for pain elimination vs. staffs' focus on symptom reduction and function (e.g., patient-staff disconnect).

CONCLUSIONS

These findings are important for determining how treatments can best fit the needs of under-resourced older adults with chronic pain.

Association between persistent musculoskeletal pain and incident sarcopenia in China: the mediating effect of depressive symptoms

Objective

To evaluate the association between musculoskeletal pain and incident sarcopenia and further explore the mediating effect of depressive symptoms among middle-aged and older Chinese adults.

Methods

Using the data from the China Health and Retirement Longitudinal Study 2011 and 2015, we included 12,788 participants in the cross-sectional analysis and 8,322 for the longitudinal analysis. Musculoskeletal pains located in the neck, back, waist, shoulder, arm, wrist, leg, knee, and ankle were self-reported at baseline and follow-up. The diagnosis criteria of sarcopenia was based on the Asian Working Group for Sarcopenia 2019. Multivariable logistic regression models were used to evaluate the association between musculoskeletal pain, and the Karlson-Holm-Breen (KHB) method was used to explore the mediating effect of depressive symptoms.

Results

Over the 4-year follow-up, 445 participants were identified with incident sarcopenia. In the longitudinal analysis, participants with baseline musculoskeletal pain (adjusted odds ratio (OR): 1.37, 95% confidence interval (CI): 1.07-1.76), persistent musculoskeletal pain (OR:1.68, 95%CI: 1.28-2.24), and persistent waist pain (OR:1.46, 95%CI: 1.04-2.03) were significantly associated with increased the risk of incident sarcopenia. Furthermore, depressive symptoms were found to partially mediate the association between musculoskeletal pain and incident sarcopenia.

Conclusion

Persistent musculoskeletal pain, especially in waist area, was positively associated with a higher risk of sarcopenia among the middle-aged and older Chinese. Depressive symptoms played a partial mediating role in this association.

Enhancing Emergency Department Pain Management for Older Adults with the Hip Fracture Fast-Track (HFFT) Protocol in a Middle-Income Country

Purpose

This study aimed to evaluate the impact of the Hip Fracture Fast-Track (HFFT) protocol, designed specifically for older patients at our hospital, which commenced on January 1, 2022, on the management of emergency department (ED) pain in older adults with hip fractures.

Patients and Methods

Retrospective pre- and post-study data from electronic health records (EHR) at our hospital, using the International Classification of Diseases (ICD)-10 codes S72.0, S72.1, S72.8, and S72.9, were utilized. The study included patients aged 65 years or older who presented to the ED with low-energy, non-pathologic isolated hip fractures or proximal femur fractures. The pre-HFFT period included patients from January 1, 2020, to December 31, 2021, and the post-HFFT period included patients from January 1, 2022, to October 31, 2023. Data were compared for the proportion of patients undergoing pain evaluation in the ED, before discharge, time to first analgesia, number of patients receiving pain relief in the ED, and the use of fascia iliaca compartment blocks (FICBs) and pericapsular nerve group blocks (PENGBs).

Results

The final analysis involved 258 patients, with 116 in the pre-protocol group and 142 in the post-protocol group. The rate of analgesic use increased significantly in the post-HFFT group (78 [67.24%] vs 111 [78.17%], P = 0.049). The rate of pain score screening at triage increased from 51.72% before the HFFT protocol to 86.62% post-HFFT protocol (p < 0.001). Compared with the pre-HFFT protocol, the post-HFFT protocol exhibited a higher rate of FICB (0% vs 14.08%, p < 0.001) and PENGB (0% vs 5.63%, p = 0.009) administration.

Conclusion

The HFFT protocol's implementation was associated with improved ED pain evaluation and analgesic administration in older adults with hip fractures. These findings indicate that tailored protocols, such as the HFFT, hold promise for enhancing emergency care for this vulnerable population.

Gender differences in the quantitative and qualitative assessment of chronic pain among older people

Background

Pain, regardless of its causes, is a subjective and multidimensional experience that consists of sensory, emotional and cognitive factors that cannot be adequately captured by a single number on a pain scale. The aim of the study was to understand gender differences in the assessment of quantitative and qualitative chronic pain among older people.

Methods

The study used a questionnaire that included questions about demographic and social characteristics as well as the following scales: Abbreviated Mental Score (AMTS), Personal Activities of Daily Living (PADL) by Katz, Instrumental Activities of Daily Living (IADL) by Lawton, Geriatric Depression Scale (GDS-15), McGill Pain Questionnaire (MPQ).

Results

The pain rating index based on rank values of adjectives was higher among women than men (18.36 ± 7.81 vs. 17.17 ± 9.69, p = 0.04). The analysis of the frequency of selection of individual adjectives describing the sensory aspects of pain showed that men described the pain as "stabbing" more often than women (26.1% vs. 14.3%, p < 0.05). Women chose adjectives from the emotional category more often than men (59.8% vs. 75.4%, p < 0.05), describing the pain as "disgusting" (8.9% vs. 1.4%, p < 0.05), "unbearable" (19.6 vs. 4.3, p < 0.05). In the subjective category, there was a difference between women and men in terms of describing pain as "terrible" (23.2% vs. 7.2%, p < 0.05) and as "unpleasant" (11.6% vs. 23.3%, p < 0 0.05).

Conclusion

When referring to pain, women tend to employ more detailed and factual language, indicative of heightened emotional sensitivity. Men tend to use fewer words and focus on the sensory aspects of pain. Subjective aspects of pain were demonstrated by both women and men.

Age-Related Risk of Serious Fall Events and Opioid Analgesic Use

Importance

Opioid analgesics may be associated with increased risk of falls, particularly among older adults.

Objective

To quantify the age-related risk of serious fall events among adults prescribed opioids by opioid exposure, time from initiation, and daily dose.

Design, Setting, and Participants

This population-based cohort study conducted in New South Wales, Australia, used data linking national pharmaceutical claims to national and state datasets, including information on sociodemographic characteristics, clinical characteristics, medicines use, health services utilization, and mortality (POPPY II study). It included adults (18 years or older) who initiated prescription opioid treatment, which was defined as no prior dispensing during the preceding 365 days, between January 1, 2005, and December 31, 2018. Data were analyzed from February to June 2023.

Exposure

Time-dependent periods of opioid exposure were evaluated from dispensing records.

Main Outcome and Measures

Serious fall events identified from emergency department, hospitalization, and mortality records. Negative binomial models were used to assess associations between time-dependent opioid exposure (overall, by time from initiation, and by dose), age, and risk of fall events. Models were adjusted for known fall risk factors, including other fall risk-increasing drugs, frailty risk, and prior serious fall events.

Results

The cohort comprised 3 212 369 individuals who initiated prescription opioid treatment (1 702 332 women [53%]; median [IQR] age at initiation, 49 [32-65] years). Overall, 506 573 serious fall events were identified, including 5210 fatal falls. During exposure to opioids, the risk of serious fall events was elevated among all age groups; compared with the group aged 18 to 44 years, this risk was highest among those 85 years or older (adjusted incident rate ratio, 6.35; 95% CI, 6.20-6.51). Across all age groups, the first 28 days following opioid initiation was a time of increased serious fall risk; this risk increased with age. Among individuals aged 18 to 84 years, associations were identified between higher daily opioid doses and serious fall events.

Conclusions and Relevance

The results of this cohort study suggest that prescription opioids were associated with increased risk of serious fall events among adults of all ages, with individuals 85 years or older at greatest risk. These risks should be considered when prescribing opioids, particularly for individuals with preexisting risk factors or when opioids are prescribed at higher doses. Targeted falls prevention efforts may be most effective within the first month following opioid initiation.

Agreement Between a Colorimetric Assay and Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry for Quantifying Paracetamol Plasma Concentrations

Special populations, like geriatric patients, experience altered paracetamol pharmacokinetics (PK), complicating pain management. More PK research is essential to optimize paracetamol (acetaminophen) dosing. Yet, the reference method ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) is not readily available. Therefore, we aimed to evaluate the agreement between UPLC-MS/MS and the more accessible colorimetric Roche acetaminophen (ACETA) assay in quantifying paracetamol plasma concentrations, to facilitate PK studies and therapeutic drug monitoring for pain management. Patient data and plasma samples were obtained from a prospective study including geriatric patients admitted to the geriatric wards. ACETA and UPLC-MS/MS assays were performed in two separate laboratories. Bland-Altman plot and Passing-Bablok regression were used to assess agreement. Accuracy was evaluated using the McNemar test for a threshold value of 10 mg/L. Population PK modeling was employed to bridge PK data obtained from both methods (NONMEM 7.5). A total of 242 plasma sample pairs were available from 40 geriatric patients (age range, 80-95 years). Paracetamol plasma concentrations from ACETA (median 9.8 [interquartile range 6.1-14.4] mg/L) and UPLC-MS/MS (9.5 [6.2-14.8] mg/L) did not differ significantly (P > 0.05). No significant proportional nor additive bias was observed between both assay methods. The classification accuracy (at threshold 10 mg/L) was 85% (P = 0.414). The conversion factor between ACETA and UPLC-MS/MS was estimated at 1.06 (relative standard error 5%), yet with a 13.4% (relative standard error 23%) interindividual variability. ACETA assay showed no systematic bias in comparison with the UPLC-MS/MS assay in determining paracetamol exposure in geriatric blood samples despite the imprecision.

A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain

OBJECTIVE

Our study aimed to investigate the analgesic efficacy of nebulized ketamine in managing acute moderate-to-severe musculoskeletal pain in older emergency department (ED) patients compared with intravenous (IV) morphine.

METHODS

This was a non-inferiority, double-blind, randomized controlled trial conducted at a single medical centre. The patients aged 65 and older, who presented at the ED musculoskeletal pain within 7 days and had a pain score of 5 or more on an 11-point numeric rating scale (NRS), were included in the study. The outcomes were a comparison of the NRS reduction between nebulized ketamine and IV morphine 30 minutes after treatment, incidence of adverse events and rate of rescue therapy.

RESULTS

The final study included 92 individuals, divided equally into two groups. At 30 minutes, the difference in mean NRS between the nebulized ketamine and IV morphine groups was insignificant (5.2 versus 5.7). The comparative mean difference in the NRS change from baseline between nebulized ketamine and IV morphine [-1.96 (95% confidence interval-CI: -2.45 to -1.46) and -2.15 (95% CI: -2.64 to -1.66) = 0.2 (95% CI: -0.49 to 0.89)] did not exceed the non-inferiority margin of 1.3. The rate of rescue therapy did not differ between the groups. The morphine group had considerably higher incidence of nausea than the control group (zero patients in the ketamine group versus eight patients (17.4%) in the morphine group; P = 0.006).

CONCLUSIONS

Nebulized ketamine has non-inferior analgesic efficacy compared with IV morphine for acute musculoskeletal pain in older persons, with fewer adverse effects.

Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic

BACKGROUND

Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities).

OBJECTIVE

We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic.

METHODS

We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing).

RESULTS

We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake.

CONCLUSIONS

We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52117.

A self-administered moxibustion-cum-massage intervention for older adults with chronic pain in the community: A randomized controlled trial

OBJECTIVES

To determine the effectiveness of a simple, self-administrable moxibustion-cum-massage intervention for relieving chronic pain and improving psychological well-being for older adults in the community.

DESIGN

A randomized controlled trial.

SETTING

Seventy-eight participants with chronic pain were randomly assigned to the intervention and waitlist control groups.

INTERVENTIONS

Participants received two moxa sticks a day to use the moxibustion-cum-massage procedure with the help of trained volunteers or caregivers for five consecutive days.

MAIN OUTCOME MEASURES

Participates' pain level, sleep quality, depression and subjective well-being were measured before the intervention (T0), immediately after the intervention (T1), and one week after the intervention (T2).

RESULTS

Repeated measures ANOVA revealed a significant group × time interaction effect in subjective well-being with a medium effect size. Regarding within-group effects in the intervention group at post-intervention (T1), the subjective pain level was significantly reduced with a small effect size, while sleep quality and depression significantly improved with large effect sizes. The control group showed no significant within-group effects in these variables. Maintenance effects at follow-up (T2) were not significant.

CONCLUSION

Despite the short intervention timeframe of five days, the study revealed preliminary evidence that the moxibustion-cum-massage intervention can be an effective, self-administrable pain relief regime for older adults. A longer period of intervention time is suggested for future studies.

The Relationship Between Pain Intensity and Pain-Related Activity Patterns in Older Adults with Chronic Musculoskeletal Pain: Mediating Roles of Pain Resilience and Pain Catastrophizing

Purpose

To explore the relationship between pain intensity, pain resilience, pain catastrophizing, and pain-related activity patterns in older adults with chronic musculoskeletal pain (CMP).

Patients and Methods

A total of 220 elderly Chinese with chronic musculoskeletal pain were recruited from a tertiary general hospital. Participants completed several measures including a demographic questionnaire, Brief Pain Inventory (BPI), Pain Resilience Scale (PRS), Pain Catastrophizing Scale (PCS), and Patterns of Activity Measure-Pain (POAM-P). Moreover, Process version 3.5 plug-in SPSS26 was used to test the mediation effect between variables.

Results

The scores of POAM-P in older adults with CMP from high to low were: avoidance (27.39 ± 8.10), pacing (24.25 ± 9.48), and overdoing (16.65 ± 10.95). Mediation analysis revealed that pain resilience and pain catastrophizing mediated the relationship between pain intensity and pain-related activity patterns (avoidance and pacing) in older adults with CMP.

Conclusion

These results provide evidence for the role of pain resilience and pain catastrophizing in the relationship between pain intensity and pain-related activity patterns. Interventions targeting these factors should be included in activity management programs for elderly CMP patients. It may be possible to reduce the negative impact of pain intensity on activity patterns by improving pain resilience and reducing pain catastrophizing.

Social network change after new-onset pain among middle-aged and old European adults

OBJECTIVE

This study examines how onset of chronic pain affects characteristics of personal social networks among adults aged 51+ across Europe.

METHODS

We used population-based data from the Survey of Health, Ageing and Retirement in Europe (SHARE; 2011-2015; n = 12,647). Using a change score analysis approach, we tracked changes in personal social networks of respondents experiencing new-onset chronic pain (n = 3803) compared to pain-free counterparts (n = 8844) in 11 European countries over four years.

RESULTS

Overall, consistent with network activation theory, respondents with new-onset mild-to-moderate chronic pain reported increases in sizes and diversity of their personal social networks, compared to their pain-free counterparts. However, consistent with the "pain as threat to the social self" theory, respondents with new-onset moderate pain or mild-to-moderate pain reported a decrease over time in perceived satisfaction and closeness with networks, respectively. Estimates from interactions between new-onset pain severity and sex show that men with new-onset pain experienced greater decreases in network satisfaction (mild pain) and closeness (severe pain) than did women.

DISCUSSION

This study highlights the complex social consequences of chronic pain, which may vary based on pain severity, gender, and type of social outcome considered.

The Effects of High-Speed Resistance Training on Health Outcomes in Independent Older Adults: A Systematic Review and Meta-Analysis

Human ageing involves several physiological impairments—in particular, a decrease in sensorimotor function and changes in the nervous system reduce muscle strength, power, balance, and functional capacity performance. Preventive strategies are essential to ensure the quality of life of the elderly. High-speed resistance training (HSRT) may be an effective approach to muscle power development in this population, with significant short-term effects on neural adaptations and muscle power production. Therefore, the present study intends to analyze and systematize the studies focused on HSRT interventions and their effects on health outcomes in independent older adults. Four electronic databases (PubMed, Web of Science, EBSCO, and Scielo) were used for the purposes of searching randomized controlled trials that measured at least one key outcome measure focusing on velocity-based training and health outcomes in older adults on 7 March 2022 and identified 1950 studies. At the end of the process, fourteen studies were included in this systematic review and ten studies were included in the quantitative analysis. The main results showed that HSRT interventions would improve health measures, mostly cognitive function (large effects, p = 0.001, SMD = 0.94), neuromuscular function (moderate effects, p = 0.003, SMD = 0.70), and physical function (moderate effects, p = 0.04, SMD = 0.55 and p = 0.009, SMD = −0.59). Additionally, the results suggested that interventions with ten weeks or more, performed three times a week, provide significant improvements in neuromuscular function. In this sense, HSRT is effective for improving overall health outcomes in older adults. Future studies should include proper follow-ups (e.g., minimum six months) to assess the durability of HSRT intervention effects on all health-related variables.

Musculoskeletal Pain in Older Adults: A Clinical Review

Persistent pain in older adults is a widely prevalent and disabling condition that is the manifestation of multiple contributing physical, mental, social, and age-related factors. To effectively treat pain, the clinician must assess and address contributing factors using a comprehensive approach that includes pharmacologic and nonpharmacologic therapies within the context of a strong therapeutic relationship among the patient, caregivers, and a multidisciplinary team. This article reviews the current understanding of persistent pain in older adults and suggests a general approach to its assessment and management, followed by specific considerations for musculoskeletal pain conditions commonly seen in older adults.

Effects of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain: a protocol of a systematic review

BACKGROUND

Chronic musculoskeletal pain affects the quality of life of older adults by interfering in their ability to perform activities of daily living. Aerobic exercise programs have been used in the treatment of various health conditions, including musculoskeletal disorders. However, there is still little evidence on the effects of aerobic exercise for the treatment of older adults with chronic musculoskeletal pain. Thus, the objective of this study is to assess the effects of aerobic exercise in improving pain and function of older adults with chronic pain as a consequence of different chronic musculoskeletal conditions.

METHODS

The databases to be used in the search are PubMed, EMBASE, CINAHL, PEDro, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials that used aerobic exercise in the treatment of older adults with chronic musculoskeletal pain will be included. Primary outcomes will be pain and function. We will use the PEDro scale to evaluate the methodological quality and statistical description of each included study, and the strength of the recommendations will be summarized using GRADE.

DISCUSSION

The results of this systematic review will provide a synthesis of the current evidence on the effects of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain. In addition, this information can help health professionals in decision-making about the use of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain.

ETHICS AND DISSEMINATION

This systematic review was recorded prospectively, and the results will be part of a doctoral thesis to be published in a peer-reviewed international journal and possibly presented at international conferences.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42019118903.

Impact of musculoskeletal pain on balance and concerns of falling in mobility-limited, community-dwelling Danes over 75 years of age: a cross-sectional study

BACKGROUND

In older adults, musculoskeletal pain is associated with increased concerns of falling, reduced balance and increased occurrence of falls. In younger adults, the intensity of neck pain and low back pain is associated with increased postural sway. It is not known if pain further impairs balance and concerns of falling in mobility-limited older adults, and if so, whether this is associated with different intensities of pain.

OBJECTIVE

This study examined whether mobility-limited older adults with mild or intense neck pain and/or low back pain have significantly increased postural sway as measured by centre of pressure (COP) changes and concerns of falling compared to those without pain.

METHODS

48 older adults with a gait speed of < 0.9 m/s from Odense, Denmark were recruited through the public health service. Self-reported neck pain, low back pain, and concerns of falling were recorded on questionnaires. Sway range, velocity and area were recorded on a force plate in a comfortable standing stance. Pain intensity was rated on an 11 point numerical rating scale (0-10). Participants were sub-grouped into mild (0-4) and intense (> 5) neck pain or low back pain.

RESULTS

Intense neck pain was associated with increased anterior-posterior sway range and area of sway. Intense low back pain was associated with increased concerns of falling.

CONCLUSION

Intense neck pain in mobility-limited older adults is associated with significant changes in postural balance, and intense low back pain is associated with significantly higher concerns of falling.

Biopsychosocial Measures Related to Chronic Low Back Pain Postural Control in Older Adults

This study examined the biopsychosocial measures related to postural control in the growing population of older adults (i.e., 60 years and older). The sample of the study consisted of 129 older adults (M = 74.45, SD = 6.95), with 34 males and 95 females; 36 were classified with chronic low-back pain (CLBP), and 93 without chronic low-back pain (NCLBP). Physical and psychosocial constructs were analyzed as predictors for postural control measures. Additionally, gender and classification of low-back pain were examined as moderators for all physical and psychosocial measures. Results demonstrated that physical and psychosocial measures were able to significantly predict composite, visual, and vestibular balance measures, but not somatosensory or preference balance measures. The chair-stand test, modified sit-and-reach test, sleep disturbance, and balance efficacy were all identified as individually significant predictors. Gender and CLBP did not moderate the utility of any predictor variables. Results of the current study re-confirm the importance of utilizing the biopsychosocial approach for future research examining postural control in older adults.

Prevalence of chronic pain in the elderly Polish population - results of the PolSenior study

INTRODUCTION

Pain is the most common complaint of elderly people. In Poland, no large studies on the prevalence of chronic pain in the elderly were conducted until recently.

MATERIAL AND METHODS

The study was a part of the PolSenior project, a cross-sectional multidisciplinary study on ageing of the Polish population, and included a randomly selected group of 716 people aged 55-59 years, and 4979 people over 65 years. The survey was conducted through a standardized questionnaire. An evaluation of pain occurrence, location, intensity and coexistence of pains in relation to gender, age and use of health care was performed.

RESULTS

Chronic pain affected 42.0% of respondents aged 65 years and over (48.6% of women and 35.8% of men) as compared to 35.2% of the pre-elderly. The most common pain locations were the lumbar region (51.6%) and knees (41.0%). The average number of pain sites was 3.1 ±2.3. Average intensity of pain was 6.2 points on the VAS scale in people over 65 years and 6.0 points in the pre-elderly (NS). Average pain intensity increased significantly from 5.7 points in patients reporting pain in one place to 7.2 points in those reporting six pain sites. Elderly respondents with pain compared to those without pain more frequently reported physician visits performed at least once a month (54.6% vs. 48.4%, p < 0.001).

CONCLUSIONS

Polish elderly most frequently complained of low back and lower limb pain. In respondents reporting many sites of pain, an increase in the intensity of pain was observed. Elderly patients with chronic pain often use medical care.

Move it or Lose it. Is it Reasonable for Older Adults with Osteoarthritis to Continue to Use Paracetamol in Order to Maintain Physical Activity?

Osteoarthritis is a common progressive disease in older adults, and those affected often have impaired physical function, co-existing disease states, and reduced quality of life. In patients with osteoarthritis, pain is reported as a primary cause of mobility limitation, and guidelines recommend a mix of pharmacologic and non-pharmacologic strategies for pain management. The benefits of exercise in the management of osteoarthritis are well established; however, pain appears to be the biggest barrier to patients engaging in, and adhering to, physical activity programs. Attitudes towards the use of pain medications differ widely, and lack of efficacy or fear of side effects may lead to sub-therapeutic dosing. Furthermore, a recent review suggesting that short-term paracetamol use is ineffective for osteoarthritis has added to the confusion. This narrative review investigates limitations of current medications, summarizes patient attitudes toward the use of analgesics for osteoarthritis pain (with a focus on paracetamol), and explores the uptake of physical activity for osteoarthritis management. Evidence suggests that, despite clear guidelines, symptoms of osteoarthritis generally remain poorly managed. More research is required to investigate clinical outcomes in patients with osteoarthritis through optimized medication plans to better understand whether longer-term analgesic use in conjunction with physical activity can assist patients to overcome mobility limitations.

Effect of Pain and Mild Cognitive Impairment on Mobility

OBJECTIVES

To examine the effect of pain and mild cognitive impairment (MCI)-together and separately-on performance-based and self-reported mobility outcomes in older adults in primary care with mild to moderate self-reported mobility limitations.

DESIGN

Cross-sectional analysis.

SETTING

Academic community outpatient clinic.

PARTICIPANTS

Individuals aged 65 and older in primary care enrolled in the Boston Rehabilitative Impairment Study in the Elderly who were at risk of mobility decline (N=430).

MEASUREMENTS

Participants with an average score greater than three on the Brief Pain Inventory (BPI) were defined as having pain. MCI was defined using age-adjusted scores on a neuropsychological battery. Multivariable linear regression models assessed associations between pain and MCI, together and separately, and mobility performance (habitual gait speed, Short Physical Performance Battery), and self-reports of function and disability in various day-to-day activities (Late Life Function and Disability Instrument).

RESULTS

The prevalence of pain was 34% and of MCI was 42%; 17% had pain only, 25% had MCI only, 17% had pain and MCI, and 41% had neither. Participants with pain and MCI performed significantly worse than all others on all mobility outcomes (P<.001). Participants with MCI only or pain only also performed significantly worse on all mobility outcomes than those with neither (P<.001).

CONCLUSION

Mild to moderate pain and MCI were independently associated with poor mobility, and the presence of both comorbidities was associated with the poorest status. Primary care practitioners who encounter older adults in need of mobility rehabilitation should consider screening them for pain and MCI to better inform subsequent therapeutic interventions.

Musculoskeletal pain characteristics associated with lower balance confidence in community-dwelling older adults

OBJECTIVE

To determine whether musculoskeletal pain (pain severity and number of chronic pain sites; single or multisite) is associated with balance confidence over and above previously established risk factors.

DESIGN

Cross-sectional study.

SETTING

Ten community sites (five day centres, two sheltered housing schemes and three community 'clubs') in the UK.

PARTICIPANTS

Two hundred and eighty-nine community-dwelling older adults [response rate 72%, mean age 78 (standard deviation 8) years, 67% female] completed the study assessment. Eligibility criteria were as follows: living in the community; aged ≥60 years; able to walk ≥10m; able to communicate in English; and no cognitive (e.g. dementia), neurological or mental health conditions.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Balance confidence as measured by the 16-item Activities Balance Confidence (ABC) scale (lower scores indicate less confidence).

RESULTS

One hundred and fifty participants had at least one site of chronic musculoskeletal pain (52%), and the remaining 139 (48%) participants did not report chronic musculoskeletal pain. Older people with chronic musculoskeletal pain had significantly lower scores on the ABC scale compared with those without chronic musculoskeletal pain (mean 48.3 vs 71.3, P<0.001). After adjustment for established risk factors, two separate hierarchical regression models demonstrated that both pain severity (β=-0.106, P=0.029) and number of chronic musculoskeletal pain sites (β=-0.98, P=0.023) were significantly associated with lower balance confidence.

CONCLUSION

Both pain severity and number of chronic pain sites (particularly multisite pain) are associated with lower balance confidence in community-dwelling older adults. Further research is needed to target pain symptoms and balance confidence in relation to fall risk in older adults with chronic musculoskeletal pain.

Automaticity of walking: functional significance, mechanisms, measurement and rehabilitation strategies

Automaticity is a hallmark feature of walking in adults who are healthy and well-functioning. In the context of walking, “automaticity” refers to the ability of the nervous system to successfully control typical steady state walking with minimal use of attention-demanding executive control resources. Converging lines of evidence indicate that walking deficits and disorders are characterized in part by a shift in the locomotor control strategy from healthy automaticity to compensatory executive control. This is potentially detrimental to walking performance, as an executive control strategy is not optimized for locomotor control. Furthermore, it places excessive demands on a limited pool of executive reserves. The result is compromised ability to perform basic and complex walking tasks and heightened risk for adverse mobility outcomes including falls. Strategies for rehabilitation of automaticity are not well defined, which is due to both a lack of systematic research into the causes of impaired automaticity and to a lack of robust neurophysiological assessments by which to gauge automaticity. These gaps in knowledge are concerning given the serious functional implications of compromised automaticity. Therefore, the objective of this article is to advance the science of automaticity of walking by consolidating evidence and identifying gaps in knowledge regarding: (a) functional significance of automaticity; (b) neurophysiology of automaticity; (c) measurement of automaticity; (d) mechanistic factors that compromise automaticity; and (e) strategies for rehabilitation of automaticity.

Choice of nonpharmacological pain therapies by ethnically diverse older adults

SUMMARY 

Aim: This study compared nonpharmacological pain therapies used by ethnically diverse older adults with recommendations of family physicians and identified factors associated with nonpharmacological pain therapies use. Methods: Using a descriptive cross-sectional design, 281 participants in four ethnic groups (European Americans, Hispanics, African–Americans, Afro-Caribbeans) with chronic pain were surveyed. Binary logistic regression analyses were employed to determine associated factors. Results & conclusion: Nonaquatic exercise and physical therapy were most frequently recommended by physicians, and nonaquatic exercise was most commonly used by participants. Lower pain levels predicted use of nonaquatic exercise, and ethnicity predicted use of prayer to manage chronic pain. Future research should examine barriers to use of psychological treatments and assess the value of combined physical and psychological treatments.

Knee extensor and flexor muscle power explains stair ascension time in patients with unilateral late-stage knee osteoarthritis: a cross-sectional study

OBJECTIVES

To determine the extent of asymmetrical deficits in knee extensor and flexor muscles, and to examine whether asymmetrical muscle deficits are associated with mobility limitations in persons with late-stage knee osteoarthritis (OA).

DESIGN

Cross-sectional.

SETTING

Research laboratory.

PARTICIPANTS

A clinical sample (N=56; age range, 50-75y) of eligible persons with late-stage knee OA awaiting knee replacement.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Knee extensor and flexor power and torque assessed isokinetically; thigh muscle cross-sectional area (CSA) assessed by computed tomography; mobility limitation assessed by walking speed and stair ascension time; and pain assessed with the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire.

RESULTS

The asymmetrical deficits in knee extensor and flexor power and torque were between 18% and 29% (P<.001). Regarding the thigh muscle CSA, the asymmetrical deficit was 4% (P<.001). Larger asymmetrical knee extensor power deficits and weaker knee extensor and flexor power on the contralateral side were associated with slower stair ascension times. Moreover, weaker knee extensor and flexor power on the ipsilateral side were associated with slower stair ascension times. Greater knee pain in the OA joint was independently associated with slower stair ascending time in both models.

CONCLUSIONS

The knee extensor and flexor muscle power of both the ipsilateral and contralateral sides and the pain in the OA knee were independently associated with stair ascension times. These results highlight the importance of assessing muscle power on both sides and knee pain in the prevention of mobility limitations in patients with knee OA.

Pain interference is associated with psychological concerns related to falls in community-dwelling older adults: multisite observational study

BACKGROUND

Pain interference and psychological concerns related to falls (PCRF) are pervasive phenomena among community-dwelling older adults, yet their association remains elusive.

OBJECTIVE

The purpose of this study was to establish whether pain interference is associated with PCRF in community-dwelling older adults.

DESIGN

This was a multisite cross-sectional study.

METHOD

Two hundred ninety-five community-dwelling older adults (mean age=77.5 years, SD=8.1; 66.4% female) participated in the study. All participants completed the Brief Pain Inventory (BPI) interference subscale, Short Falls Efficacy Scale-International (FES-I), Activities-specific Balance Confidence Scale (ABC), modified version of the Survey of Activities and Fear of Falling in Elderly Scale (mSAFFE), and Consequences of Falling Scale (CoF). Hierarchical multiple regression analysis were conducted. In the first step of the study, sociodemographic and known risk factors for psychological concerns related to falls were inserted into the model, followed by the BPI interference subscale score in the second step.

RESULTS

One hundred sixty-nine participants (57.3%) reported some pain interference. The BPI interference subscale was highly correlated with all PCRF (r>.5, P<.0001). After the adjustment for established risk factors, the BPI interference subscale significantly increased the variance in the Short FES-I (R2 change=13.2%), ABC (R2 change=4.7%), mSAFFE (R2 change=5.0%), and CoF (R2 change=10.0%). Pain interference was a significant and independent predictor in the final model for the Short FES-1 (β=0.455, P<.001), ABC (β=-0.265, P<.001), mSAFFE (β=0.276, P<.001), and CoF (β=0.390, P<.001).

LIMITATIONS

The study was cross-sectional.

CONCLUSIONS

Pain interference is an important contributing factor in each of the psychological concerns related to falls. Pain interference had the strongest impact on reducing falls efficacy and increasing older adults' concerns about the consequences of falling.

Physician practicing preferences for conventional or homeopathic medicines in elderly subjects with musculoskeletal disorders in the EPI3-MSD cohort

BACKGROUND

Musculoskeletal pain is common in elderly persons. Analgesic use is high in the elderly and may involve unacceptable risk in individuals with chronic pain. Our aim was to compare the socio-demographic characteristics of elderly subjects with musculoskeletal disorders (MSD) and to assess medication use and clinical evolution of musculoskeletal pain according to physician prescribing preference: homeopathy (Ho) group, conventional medicine (CM) group, or mixed prescription (MX) group.

METHODS

The EPI3 study was a 1 year observational survey carried out among general practitioners in France between March 2007 and July 2008. This sub-analysis was carried out on elderly subjects aged ≥70 years from the original EPI3 cohort. Socio-demographic data were collected at inclusion using a self-administered patient questionnaire and medical data were recorded for each patient. Quality of life was measured using the Short Form-12 questionnaire. Patients completed a structured telephone interview on their functional status (evaluated with the QuickDash questionnaire, EIFEL scale or Lequesne index) within 72 hours of inclusion. This telephone interview was repeated at 1, 3, and 12 months. Drug exposure was also assessed during these interviews.

RESULTS

146 patients (mean age ± standard deviation: 75.8±4.8 years) were analyzed (80.1% female, 74.7% MSD of the spine or lower limbs, 64.4% chronic MSD). Patients in the CM and MX groups were 3.7 times or 2.5 times more likely (odds ratio [OR] =3.71, 95% confidence interval [CI]: 1.12-12.30; OR =2.52, 95% CI: 1.05-6.05; respectively) to have used non-steroidal anti-inflammatory drugs (NSAIDs) than those in the Ho group. In contrast, analgesic use was comparable in the three groups (OR =1.06 [CM versus Ho], 95% CI: 0.09-12.11; OR =0.34 [MX versus Ho], 95% CI: 0.07-1.57). Overall functional score evolution was similar in the three groups over time (P=0.16).

CONCLUSION

NSAID use was significantly higher in elderly MSD patients consulting a conventional practice general practitioner. In contrast, analgesic use and MSD evolution were similar in the three groups. Consulting a homeopathic physician for MSD management does not appear to represent a loss of therapeutic opportunity, and decreases the use of NSAIDs.

The avoidance of activities due to fear of falling contributes to sedentary behavior among community-dwelling older adults with chronic musculoskeletal pain: a multisite observational study

OBJECTIVE

Physical inactivity and sedentary behavior (SB) are leading causes of mortality. We investigated if older adults with chronic musculoskeletal pain (CMP) are more sedentary than a group of similar age and sex without CMP and possible contributory factors to this.

METHOD

In this multisite observational study, 285 community-dwelling older adults (response rate 71%) took part. One hundred forty-four had CMP (78.4 years, 65.9% female), and 141 formed the comparison group without CMP. Details regarding falls were collected, and all participants completed the brief pain inventory (BPI), modified version of the survey of activities and fear of falling in elderly scale (mSAFFE), and the International Physical Activity Questionnaire (IPAQ) to measure SB. Data were analyzed with hierarchical regression analysis.

RESULTS

Older adults with CMP spent approximately 3 1/2 hours a day more being sedentary than the comparison group (11.5 hours vs 7.9, P<0.001). The addition of BPI interference and mSAFFE scores in the regression analysis resulted in an R(2) change of 10.4% in IPAQ scores, over and above the variance explained by the background demographic, medical, and mobility factors. Excessive concerns about the consequences of falling did not increase the variance in SB. Within the final model, mSAFFE scores were the largest independent predictor of SB (β=0.461, P<0.001).

CONCLUSIONS

Older adults with CMP are significantly more sedentary than those of a similar sex and age without CMP. It appears that the avoidance of activities due to fear of falling is a significant contributory factor to SB in older adults with CMP.

How does pain localization affect physical functioning, emotional status and independency in older adults with chronic musculoskeletal pain?

[Purpose] The aim of this study was to show the impact of chronic musculoskeletal pain of the spinal column and lower extremities on physical functioning, emotional status, and independency in older adults. [Subjects] In this cross-sectional study, 258 older adults (mean age, 71.98±5.86 years, 50.8% males, 49.2% females) living in their own residences were evaluated. [Methods] Pain intensity was analyzed using a visual analogue scale. Physical functioning was evaluated with the Timed Up and Go Test (TUG) and a Six-Minute Walk Test. The Geriatric Depression Scale was used to determine emotional status. The independency in daily living of the participants was evaluated using the Lawton Brody IADL Scale. All participants were divided into two groups in accordance with the pain localization: the (1) spinal pain and (2) lower extremity pain groups. [Results] When the pain scores were compared, no significant differences between the two groups were found. The same results were found in terms of TUG scores. The spinal pain group had higher scores in terms of aerobic capacity than the lower extremity pain group. [Conclusion] The results indicate that chronic musculoskeletal pain in the lower extremities decreased aerobic capacity much more than spinal pain in older adults.

What analgesics do older people use prior to initiating oxycodone for non-cancer pain? A retrospective database study

BACKGROUND

Increased oxycodone use has been associated with adverse drug events, non-medical use and overdose deaths.

OBJECTIVES

To explore patterns of non-opioid, weak opioid and strong opioid use prior to initiation of oxycodone for non-cancer pain in a predominantly older Australian population.

METHODS

A retrospective study was conducted using the Australian Government Department of Veterans' Affairs administrative claims database. Analgesic use 12 months prior to incident dispensing of oxycodone was determined for people in the community and in residential aged-care facilities (RACFs). Log-binomial regression was used to compute adjusted rate ratios (RRs) and 95 % confidence intervals (95 % CIs) for the use of other analgesics prior to initiating oxycodone.

RESULTS

Of 10,791 people who initiated oxycodone in 2010, 26 % in community settings and 13 % in RACFs were not dispensed other analgesics in the 12 months prior to initiating oxycodone. Thirty-four percent and 20 % of those in community settings and RACFs, respectively, were not dispensed other analgesics in the previous 4 months. Co-morbidity had little impact on prior analgesic use. Each additional co-morbid condition was associated with a 1.4 % increased likelihood (RR 1.014, 95 % CI 1.012-1.016; p < 0.0001) and a 1.2 % increased likelihood (RR 1.012, 95 % CI 1.009-1.015; p < 0.0001) of being dispensed another analgesic prior to initiating oxycodone in community and RACF settings, respectively.

CONCLUSIONS

Oxycodone is frequently initiated for non-cancer pain without first trialing other analgesics. This highlights the need for prescribing practices to be reviewed in light of increasing concerns about adverse drugs events and death due to oxycodone, particularly in older people.

Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study

OBJECTIVES

To determine the effects of chronic pain on the development of disability and decline in physical performance over time in older adults.

DESIGN

Longitudinal cohort study with 18 months of follow-up.

SETTING

Urban and suburban communities.

PARTICIPANTS

Community-dwelling older adults aged 65 and older (N = 634).

MEASUREMENTS

Chronic 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.

RESULTS

Almost 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.

Diagnostic criteria for sarcopenia and physical performance

Relative and absolute muscle mass and muscle strength are used as diagnostic criteria for sarcopenia. We aimed to assess which diagnostic criteria are most associated with physical performance in 180 young (18-30 years) and 281 healthy old participants (69-81 years) of the European study MYOAGE. Diagnostic criteria included relative muscle mass (total or appendicular lean mass (ALM) as percentage of body mass), absolute muscle mass (ALM/height squared and total lean mass), knee extension torque, and handgrip strength. Physical performance comprised walking speed, Timed Up and Go test (TUG), and in a subgroup physical fitness. Diagnostic criteria for sarcopenia and physical performance were standardized, and the associations were analyzed using linear regression models stratified by age category, with adjustments for age, gender, and country. In old participants, relative muscle mass was associated with faster walking speed, faster TUG, and higher physical fitness (all p < 0.001). Absolute muscle mass was not associated with physical performance. Knee extension torque and handgrip strength were associated with faster walking speed (both p ≤ 0.003). Knee extension torque was associated with TUG (p = 0.001). Knee extension torque and handgrip strength were not associated with physical fitness. In young participants, there were no significant associations between diagnostic criteria for sarcopenia and physical performance, except for a positive association between relative muscle mass and physical fitness (p < 0.001). Relative muscle mass, defined as lean mass or ALM percentage, was most associated with physical performance. Absolute muscle mass including ALM/height squared was not associated with physical performance. This should be accounted for when defining sarcopenia.

Musculoskeletal pain and physical functioning in the oldest old

BACKGROUND

Little is known about the impact of pain on physical functioning among the oldest-old subjects. In this study, we first examined the associations between the number of painful sites and measures of physical functioning reflecting different stages of the disablement process (physical impairment, functional limitation and disability) among nonagenarians (more than ninety years old persons). Second, we described the effect of painful sites on disability during a 2-year follow-up period.

METHODS

This study is based on baseline (n = 1177) and 2-year follow-up (n = 709) data of the nationwide Danish 1905 cohort study. Musculoskeletal pain was assessed as reported pain in back, hips or knees when moving or resting. Physical performance measures included maximum grip strength and habitual walking speed. Disability in performing activities of daily living was defined as the need for assistive device or personal help in transferring, dressing, washing, using toilet and/or walking indoors.

RESULTS

At baseline, the number of painful sites was significantly associated with measured grip strength and walking speed as well as self-reported disability in a stepwise manner; the more sites with pain, the poorer the physical functioning. The follow-up analyses showed corresponding but slightly weaker stepwise associations between baseline pain and disability level at follow-up, and indicated that although on the whole, single or multi-site pain did not predict the onset of disability, multi-site pain increased the risk of developing severe disability.

CONCLUSIONS

The findings of this study suggest that musculoskeletal pain in nonagenarians is highly prevalent and is associated with poor physical performance and disability.

Hip fracture-related pain strongly influences functional performance of patients with an intertrochanteric fracture upon discharge from the hospital

OBJECTIVE

To examine whether functional performance upon hospital discharge is influenced by pain in the region of the hip fracture or related to the fracture type.

DESIGN

Prospective observational study.

SETTING

A 20-bed orthopedic hip fracture unit.

PATIENTS

Fifty-five cognitively intact patients (20 men and 35 women; ages 75.8 ± 10 years), 33 with a cervical hip fracture and 22 with an intertrochanteric hip fracture, all of whom were allowed to bear full weight after surgery.

METHODS

All patients were evaluated upon discharge from the hospital to their own homes at a mean of 10 ± 6 days after surgery.

MAIN OUTCOME MEASUREMENTS

The Timed Up & Go (TUG) test, supervised by a physical therapist, was used to evaluate functional performance, and a 5-point verbal ranking scale (0 = no pain to 4 = intolerable pain) was used to evaluate pain.

RESULTS

Patients took an average of 22.7 ± 11.7 seconds to perform the TUG. No significant differences were observed in baseline characteristics or pain medication given for patients with a cervical versus an intertrochanteric fracture (P ≥ .22), but patients with an intertrochanteric fracture presented more often with moderate to severe pain during testing (P < .001), with associated poorer performances on the TUG test (29.4 ± 12.8 seconds versus 18.3 ± 8.5 seconds). Univariate analysis showed that TUG scores were associated with age, prefracture function evaluated by the New Mobility Score, fracture type, day of TUG performance, and pain intensity. Multivariate linear regression analyses (fracture type not included) showed that only greater age (B = 0.34), low prefracture function (B = 7.9), and experiencing moderate to severe pain (B = 8.7) were independently associated with having a poorer TUG score.

CONCLUSIONS

Hip fracture-related pain primarily compromises the functional performance of patients with an intertrochanteric hip fracture upon discharge from hospital. Physical therapists should be involved in new and optimized fracture-type stratified pain management strategies.

The psycho-social dimension of pain and health-related quality of life in the oldest old

BACKGROUND

Chronic pain has an impact on the physical and social functioning of older people which in turn may worsen their health-related quality of life. Research with focus on prolonged extensive pain in the most elderly and how pain may interfere with their life situation is scarce.

AIMS

  The aims were to describe and investigate pain from a multidimensional point of view (duration, location, psycho-social) and health-related quality of life as well as to compare sex and age groups in people aged 80 years and over.

METHODS

In this cross-sectional study, a total of 225 of 282 people responded to a questionnaire consisting of two instruments and background questions. The psycho-social dimension of pain was measured using the Multidimensional Pain Inventory-Swedish language version (MPI-S) with five scales: Pain Severity, Interference, Life Control, Affective Distress and Social Support. Health-related quality of life was measured using the Short Form Health Survey-12 (SF-12).

RESULTS

Median duration of pain was 9.0 years, and the mean number of pain locations was 2.04. The MPI-S scale Interference with a negative orientation had the highest mean score, while the mean score for Social Support was the highest for the scales with a positive orientation. The duration of pain was significantly greater for women, and those aged 80-85 years had higher pain severity than those aged≥86. Participants with a lower health-related quality of life experienced significantly more severe pain, were more troubled with pain and had less control of their life.

CONCLUSIONS

Older people with prolonged pain suffered from a low health-related quality of life. Pain interfered with their lives and contributed to diminished control in their daily lives. Nurses are essential for the identification and prevention of pain and should be aware of how pain affects older people's physical, mental and social health.