Chronic pain and circumstances of falls in community-living older adults: an exploratory study

Role of Serum Brain-Derived Neurotrophic Factor as a Biomarker of Chronic Pain in Older Adults

BACKGROUND

Serum brain-derived neurotrophic factor (BDNF) has emerged as a promising biomarker for chronic pain (CP) research and treatment. Yet, most human studies have been limited by small sample sizes, inadequate control of confounders and a lack of focus on sex and mental health differences.

METHODS

This study included data from 1932 community-dwelling individuals aged ≥ 65 years, randomly sampled from the Spanish general population. Serum BDNF was quantified by ELISA. CP characteristics were assessed using the European Chronic Pain Survey and classified according to electronic medical records (ICPC-2 codes). Linear regression models-adjusted for sociodemographic, lifestyle and clinical factors-and stratified analyses by sex and depression status (defined by Geriatric Depression Scale score, recent physician diagnosis or antidepressant use) were performed.

RESULTS

Among 962 men and 970 women, mean BDNF concentrations were 18.55 (5.66) ng/mL and 19.39 (5.77) ng/mL, respectively. Most participants reported pain in multiple locations (median 3 sites, interquartile range: 2-4). In 511 participants with CP, probable musculoskeletal pain was predominant (n = 446), followed by nociplastic (n = 71), neuropathic (n = 54), visceral (n = 51) and vascular pain (n = 22). Notably, in non-depressed participants (n = 1639), women with severe or interfering pain showed lower BDNF concentrations [β coefficient (95% confidence interval) = -2.62 ng/mL (-5.03, -0.22) and -3.09 ng/mL (-4.71, -1.47), respectively] compared to those without CP-a pattern not seen in men. Conversely, among men with depression (n = 293), both severe [-5.12 g/mL (-9.26, -0.99)] and interfering [-4.95 g/mL (-8.29, -1.61)] pain were linked to lower BDNF, a trend absent in depressed women. Similar associations were observed in analyses of musculoskeletal and nociplastic pain subtypes.

CONCLUSIONS

While serum BDNF is a promising biomarker for CP, its reliability for gauging pain severity depends on patient sex and depression status. These factors must be considered to enhance the accuracy and clinical relevance of BDNF in CP evaluation.

SIGNIFICANCE

Our study is the first to reveal that the relationship between serum BDNF and chronic pain is distinctly modulated by sex and depression. This novel insight challenges one-size-fits-all biomarker approaches and paves the way for more personalised, precision-based strategies in chronic pain diagnosis and management.

Analysis of the current status and factors influencing post-traumatic stress disorder in elderly patients with knee osteoarthritis: a cross-sectional study

Existing studies have focused on post-traumatic stress disorder (PTSD) after surgery in patients with knee osteoarthritis (KOA), whereas PTSD in non-operated elderly KOA patients has not been adequately studied. The aim was to assess the current status of PTSD and its influencing factors among non-surgical elderly KOA patients. From October to November 2021, a cross-sectional study was conducted among 320 consecutive patients aged ≥ 65 years with radiologically confirmed KOA and no history of knee surgery or psychiatric disorders, recruited from three community hospitals in Changsha, Hunan Province. A total of 314 participants completed validated assessments for PTSD (PTSD Checklist-Civilian Version), pain (Numerical Rating Scale), anxiety (Generalized Anxiety Disorder Scale), depression (Patient Health Questionnaire-9), and social support (Social Support Rating Scale). Data were analyzed using non-parametric tests and Spearman correlation. Structural equation modeling (SEM) was performed with Amos 24.0, employing maximum likelihood estimation and 1000 bootstrap samples to test mediation effects. Among 314 analyzed participants (mean age 72.91 ± 6.384 years; 60.80% female and 39.20% males), PTSD prevalence was 18.20%. Significantly higher PTSD risk was associated with low education levels (Z=-2.398, P = 0.016), low salaries (H = -2.398, P = 0.005), unemployed patients (H = 10.030, P = 0.007), no exercise (H = 9.328, P = 0.025), smoking (Z = -2.504, P = 0.012) and no leisure activities (Z=-2.074, P = 0.038). Structural equation modeling revealed a direct effect of depression on PTSD with the path coefficient of 0.701 (95% CI 0.518-0.879, P = 0.001) and an indirect effect of pain on PTSD through social support with the path coefficient of -0.014 (95% CI -0.049 to -0.001, P = 0.035 < 0.05). Non-surgical elderly patients with knee osteoarthritis exhibit clinically significant post-traumatic stress disorder rates (18.20%), primarily driven by depression and mediated through pain-social support pathways. These findings underscore the need for integrated biopsychosocial interventions targeting pain management, mental health screening, and social support enhancement in this population.

Association of Pain With Falls and Fractures Among Middle-Aged Korean Community-Dwelling Adults

BACKGROUND

The relationship between pain and falls remains controversial. Therefore, this study explored the associations between pain and fall-related outcomes in 5 340 middle-aged (45-65 years) adults residing in the communities in Korea.

METHODS

Pain was defined as pain at any location, pain-related activity restriction, and persistent pain. The outcome measures included fall injuries, recurrent falls, injurious falls, and fall-related hip fractures. A multivariate logistic regression model was used to examine the relationship between pain and fall outcome.

RESULTS

Among the study participants, 54.0% reported having experienced pain. During a follow-up period of up to 14 years, those who reported pain and pain-related activity restriction at baseline exhibited a positive association with the occurrence of fall injury (odds ratio [OR] 1.79, 95% confidence interval [CI]: 1.27-2.53) and injurious falls (OR 1.72, 95% CI: 1.20-2.48) but not with recurrent falls (OR 1.90, 95% CI: 0.80-4.54). We also observed a positive association between persistent pain and the risk of fall injury (OR 1.41, 95% CI: 1.13-1.91), whereas no consistent conclusions were drawn regarding the risk of recurrent falls and injurious falls. We also did not identify any correlation between pain and hip fractures resulting from falls.

CONCLUSIONS

In conclusion, our findings of the positive correlations of pain and pain-related activity restriction at baseline with fall injuries and injurious falls but not recurrent falls during follow-up suggest that public health initiatives should prioritize pain screening, especially for participants reporting ankle and toe pain, and implement suitable interventions to mitigate the risk of falls and the associated adverse outcomes among middle-aged adults.

Flexible and Stable GaN Piezoelectric Sensor for Motion Monitoring and Fall Warning

Wearable devices have potential applications in health monitoring and personalized healthcare due to their portability, conformability, and excellent mechanical flexibility. However, their performance is often limited by instability in acidic or basic environments. In this study, a flexible sensor with excellent stability based on a GaN nanoplate was developed through a simple and controllable fabrication process, where the linearity and stability remained at almost 99% of the original performance for 40 days in an air atmosphere. Moreover, perfect stability was also demonstrated in acid-base environments, with pH values ranging from 1 to 13. Based on its excellent stability and piezotronic performance, a flexible device for motion monitoring was developed, capable of detecting motions such as finger, knee, and wrist bending, as well as swallowing. Furthermore, gesture recognition and intelligent fall monitoring were explored based on the bending properties. In addition, an intelligent fall warning system was proposed for the personalized healthcare application of elders by applying machine learning to analyze data collected from typical activities. Our research provides a path for stable and flexible electronics and personalized healthcare applications.

Evaluating functional ability in older adults' object retrieval behavior from kitchen furniture using OpenPose and REBA

The purpose of this study is to evaluate, through analysis, the ability of older persons to retrieve items from kitchen cabinets. To achieve this goal, data were collected from 128 valid questionnaires and supplemented with field research and user interviews. The study revealed that the elderly's behavior in retrieving items from kitchen spaces is characterized by both high frequency and difficulty. For this experiment, a total of 42 participants, comprising 21 males and 21 females from the self-care elderly population in the Yangtze River Delta region, were recruited. Two different experimental settings were arranged: one with kitchen utensils arranged in a straight line and another with a purpose-made chest of drawers with varying heights. Video recordings using the Logitech C930C were utilized to capture the gestures and behaviors of the elderly while retrieving objects from the kitchen cupboards (cabinets). By employing a combination of the OpenPose model and the Rapid Entire Body Assessment (REBA) method, which involves calculating human posture angles, REBA scores, and determining the risk level of Work-Related Musculoskeletal Disorders (WMSDs), a risk assessment framework for manual operations associated with WMSDs was developed. Using the angle data acquired from the user operation experiment as parameters, a gradient model of the elderly user's operational capability was established. The findings indicated a significant impact of neck, trunk, and knee movements on the subjects (P < 0.001). The participants were able to distinguish between different levels of exertion, categorizing movements as 'easy', 'moderate,' or 'strenuous.' These results form the basis for a comfort gradient model for leaning over and retrieving items. Given the prevalent conditions of bone and joint degeneration and osteoporosis among the elderly population, it is evident that they face challenges when accessing items in the kitchen. Therefore, investigating the elderly's execution abilities during the retrieval process becomes crucial. Understanding how different cabinet heights impact the joint angles of the elderly can be instrumental in optimizing cabinet designs for elderly users, thereby reducing their physical exertion in the kitchen and enhancing their comfort levels. This research holds significant value in improving the quality of life for the elderly population at home and fostering the advancement of elderly-friendly design principles.

Psychosocial Characteristics by Pain Presence and Limitations Among Older Adults

PURPOSE

To compare psychosocial outcomes of older adults according to pain experience.

METHOD

Using cross-sectional 2021 data from the National Health and Aging Trends Study, we examined psychosocial characteristics in older adults (N = 3,376) divided into three groups: no pain, pain without activity limitations, and activity-limiting pain.

RESULTS

In multiple regression models, older adults with activity-limiting pain compared to those without pain had significantly higher depression, anxiety, and fear of falling, as well as reduced positive affect, self-realization, self-efficacy, resilience, and social participation. Older adults with non-activity-limiting pain had significantly higher social participation than those without pain, but no differences in self-realization, self-efficacy, or resilience.

CONCLUSION

Pain is strongly associated with all psychosocial outcomes, especially in older adults with activity-limiting pain. Future research should examine the impact of self-realization, self-efficacy, resilience, and social participation on activity limitations. [Journal of Gerontological Nursing, 50(7), 27-34.].

Chronic pain in older adults with disabilities is associated with fall-related injuries: a prospective cohort study

PURPOSE

Previous studies have shown an association between chronic pain and the occurrence of falls in community-dwelling older adults; however, the association between chronic pain and fall-related injuries in older adults with disabilities is unclear. This study aimed to determine the association between chronic pain and fall-related injuries in older adults with disabilities.

METHODS

This 24-month prospective cohort study included older adults aged 65 years or older using Japanese long-term care insurance services. Chronic pain, defined as "pain that has persisted for more than three months to date," was assessed using a face-to-face questionnaire. Fall-related injuries, defined as "injuries requiring hospitalization or outpatient treatment due to a fall," were assessed using a fall calendar. Data were analyzed using a Cox proportional hazards model, with fall-related injury as the dependent variable, chronic pain as the independent variable, and confounders as covariates.

RESULTS

Among 133 included participants, 15 experienced fall-related injuries. After adjusting for age and sex as covariates, chronic pain was significantly associated with fall-related injuries (hazard ratio: 5.487, 95% confidence interval: 1.211-24.853, p = 0.027).

CONCLUSIONS

Chronic pain was associated with fall-related injuries in older adults with disabilities. In this population, a greater focus should be placed on treating chronic pain to reduce the occurrence of falls.

Association between multisite musculoskeletal pain and disability trajectories among community-dwelling older adults

BACKGROUND

Pain is linked to disability, but how multisite musculoskeletal pain leads to disability over time is not well elaborated.

OBJECTIVE

To examine the associations of multisite musculoskeletal pain with disability among a nationally representative cohort.

DESIGN

We used data from the National Health and Aging Trends Study (NHATS) 2015-22. Disability was assessed by basic activities of daily living (ADL) and instrumental activities of daily living (IADL).

PARTICIPANTS

A total of 5557 individuals with multisite musculoskeletal pain dwelling in the community were included in this study.

METHODS

Group-based trajectory models were applied to identify distinct profiles of disability in ADL and IADL. Design-based logistic regressions were used to examine associations among multisite musculoskeletal pain, disability, and dual trajectory group memberships, adjusted for sociodemographic, health status, behavioral, and mental characteristics.

RESULTS

Persons who experienced multisite musculoskeletal pain were at higher risk of disability in ADL and IADL. We identified five heterogeneous disability trajectories and named them based on baseline levels and rates of increase over time. Approximately, 52.42% of older adults with multisite musculoskeletal pain were in trajectories with ADL and IADL declines, and 33.60% experienced a rapid decline. Multisite musculoskeletal pain was associated with elevated relative risk for the adverse disability trajectories, which generally increases with multisite musculoskeletal pain frequency and number of sites.

CONCLUSIONS

Persons with multisite musculoskeletal pain had a higher risk of disability. It is essential to adopt effective pain management strategies to maintain the independent living ability of older adults and to realize active aging.

Multisite Pain and Intensity were Associated with History Fall among Older Adults: A Cross-Sectional Study

Purpose

This study examined the independent associations among multisite pain, pain intensity, and the risk of falls, including a history of falls in the previous 12 months and frequent falls (≥ two falls vs one or two falls) among community-dwelling older adults.

Methods

A cross-sectional design from Wave 2 of the National Social Life, Health, and Aging Project was used. Data on pain intensity and location (45 sites) over the past 4 weeks were collected. Multisite pain was categorized into four groups: none, one, two, and three or more sites. The main outcomes of falls were a history of falls and frequent falls. The covariates included age, sex, race, body mass index, education, medications, and comorbidities.

Results

Among 3,196 participants in Wave 2, 2,697 were included because of missing key variables related to pain and fall history. The prevalence of falls and frequent falls were 30.3% (n = 817) and 12.6% (n = 339), respectively. Multisite pain at ≥ three sites (odds ratio (OR) 2.04, confidence interval (CI) [1.62, 2.57]; p < 0.001) and two sites (OR 1.72, 95% CI [1.30, 2.27]; p < 0.001) was significantly associated with an increased risk of falls. An increase in pain intensity was significantly associated with an increased risk of fall (OR 1.28, 95% CI [1.15, 1.44], p < 0.001), independent of multisite pain. Multisite pain at ≥3 sites (OR 2.19, 95% CI [1.56, 3.07], p < 0.001) and 2 sites (OR 1.54, 95% CI [1.01, 2.34], p = 0.045) was associated with an increased risk of frequent falls. An increase in pain intensity was associated with risk of frequent falls (OR 1.64, 95% CI [1.40, 1.91], p < 0.001), independent of multisite pain.

Conclusion

Multisite pain and pain intensity were associated with a history of falls and frequent falls among older adults, emphasizing the need for routine pain evaluation to develop fall prevention strategies in this population.

Investigation of factors influencing low physical activity levels in community-dwelling older adults with chronic pain: a cross-sectional study

Low levels of physical activity in individuals with chronic pain can lead to additional functional impairment and disability. This study aims to investigate the predictors of low physical activity levels in individuals with chronic pain, and to determine the accuracy of the artificial neural network used to analyze these predictors. Community-dwelling older adults with chronic pain (n = 103) were surveyed for their physical activity levels and classified into low, moderate, or high physical activity level groups. Chronic pain-related measurements, physical function assessment, and clinical history, which all influence physical activity, were also taken at the same time. Logistic regression analysis and analysis of multilayer perceptron, an artificial neural network algorithm, were performed. Both analyses revealed that history of falls was a predictor of low levels of physical activity in community-dwelling older adults. Multilayer perceptron analysis was shown to have excellent accuracy. Our results emphasize the importance of fall prevention in improving the physical activity levels of community-dwelling older adults with chronic pain. Future cross-sectional studies should compare multiple analysis methods to show results with improved accuracy.

Association of Pain Phenotypes with Risk of Falls and Incident Fractures

Objective: To compare whether falls risk score and incident fracture over 10.7 years were different among three previously identified pain phenotypes. Methods: Data on 915 participants (mean age 63 years) from a population-based cohort study were studied at baseline and follow-ups at 2.6, 5.1 and 10.7 years. Three pain phenotypes were previously identified using the latent class analysis: Class 1: high prevalence of emotional problems and low prevalence of structural damage; Class 2: high prevalence of structural damage and low prevalence of emotional problems; Class 3: low prevalence of emotional problems and low prevalence of structural damage. Fractures were self-reported and falls risk score was measured using the Physiological Profile Assessment. Generalized estimating equations model and linear mixed-effects model were used to compare differences in incident fractures and falls risk score over 10.7 years between pain phenotypes, respectively. Results: There were 3 new hip, 19 vertebral, and 121 non-vertebral fractures, and 138 any site fractures during 10.7-year follow-up. Compared with Class 3, Class 1 had a higher risk of vertebral (relative risk (RR) = 2.44, 95% CI: 1.22-4.91), non-vertebral fractures (RR = 1.20, 95% CI: 1.01-1.42), and any site fractures (RR = 1.24, 95% CI: 1.04-1.46) after controlling for covariates, bone mineral density and falls risk score. Class 2 had a higher risk of non-vertebral and any site fracture relative to those in Class 3 (non-vertebral: RR = 1.41, 95% CI: 1.17-1.71; any site: RR = 1.44, 95% CI: 1.20-1.73), but not vertebral fracture. Compared with Class 3, Class 1 had a higher falls risk score at baseline (β = 0.16, 95% CI: 0.09-0.23) and over 10.7-year (β = 0.03, 95% CI: 0.01-0.04). Conclusions: Class 1 and/or Class 2 had a higher risk of incident fractures and falls risk score than Class 3, highlighting that targeted preventive strategies for fractures and falls are needed in pain population.