Pain and mortality among older adults in Korea

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.

Association Between Socioeconomic Inequalities in Pain and All-Cause Mortality in the China Health and Retirement Longitudinal Study: Longitudinal Cohort Study

BACKGROUND

Few studies focus on the equality of pain, and the relationship between pain and death is inconclusive. Investigating the distribution of pain and potential mortality risks is crucial for ameliorating painful conditions and devising targeted intervention measures.

OBJECTIVE

Our study aimed to investigate the association between inequalities in pain and all-cause mortality in China.

METHODS

Longitudinal cohort data from waves 1 and 2 of the China Health and Retirement Longitudinal Study (2011-2013) were used in this study. Pain was self-reported at baseline, and death information was obtained from the 2013 follow-up survey. The concentration index and its decomposition were used to explain the inequality of pain, and the association between pain and death was analyzed with a Cox proportional risk model.

RESULTS

A total of 16,747 participants were included, with an average age of 59.57 (SD 9.82) years. The prevalence of pain was 32.54% (8196/16,747). Among participants with pain, the main pain type was moderate pain (1973/5426, 36.36%), and the common pain locations were the waist (3232/16,747, 19.3%), legs (2476/16,747, 14.78%) and head (2250/16,747, 13.44%). We found that the prevalence of pain was concentrated in participants with low economic status (concentration index -0.066, 95% CI -0.078 to -0.054). Educational level (36.49%), location (36.87%), and economic status (25.05%) contributed significantly to the inequality of pain. In addition, Cox regression showed that pain was associated with an increased risk of all-cause mortality (hazard ratio 1.30, 95% CI 1.06-1.61).

CONCLUSIONS

The prevalence of pain in Chinese adults is concentrated among participants with low economic status, and pain increases the risk of all-cause death. Our results highlight the importance of socioeconomic factors in reducing deaths due to pain inequalities by implementing targeted interventions.

Impact of Pain on Activities of Daily Living in Older Adults: A Cross-Sectional Analysis of Korean Longitudinal Study of Aging (KLoSA)

Pain, particularly musculoskeletal (MSK) and multi-site pain, significantly impacts activities of daily living (ADL) in the elderly, leading to a decline in overall quality of life (QoL). This study, comprising 7490 participants, (mean age: 69 ± 10; females: 57%) from the sixth wave of the Korean Longitudinal Study of Aging (KLoSA), aimed to assess the association between self-reported pain and ADL impairment among the elderly population. Notably, 62% of participants reported experiencing pain, with back pain being the most prevalent (36%) and stomachache the least (0.39%). A majority (61%) of individuals reported MSK-related pain. Additionally, 20% reported pain at one site and 0.03% experienced pain at 12 sites. ADL impairment was observed in 376 (5.0%) participants. Compared to those without pain, participants reporting moderate and severe pain had higher odds of ADL impairment [2.31 (95% CI, 1.66-3.21) and 2.98 (95% CI, 1.95-4.53), respectively]. Pain experienced in the shoulder, arm, wrist, back, hip, leg, and ankle had a significant association with ADL impairment, with ORs ranging from 2.66 (95% CI, 1.80-3.93; hip pain) to 1.36 (95% CI 1.07-1.72; back pain). Furthermore, multi-site pain was associated with higher ADL impairment [1-6 sites: OR: 1.49 (95% CI, 1.11-2.01); 7-12 sites: OR: 7.16 (95% CI, 3.60-14.26)]. These findings underscore the importance of addressing MSK and multi-site pain through targeted interventions, potentially enhancing ADL and contributing to an improved QoL among the elderly population.

Assessing healthcare professionals' perceptions of pain concepts and beliefs

BACKGROUND

Healthcare professionals deliver pain education, yet their perception of pain experiences is not well understood, which can affect their interactions with patients in pain.

OBJECTIVE

This study explored Korean healthcare professionals' perceptions of the usefulness of assessing pain concepts and beliefs and the importance of domains identified in the pain literature.

METHODS

This descriptive cross-sectional study employed an online survey administered to nurses, physical therapists, and physicians, including the Neurophysiology of Pain Questionnaire, Tampa Scale for Kinesiophobia, and related optional open-ended questions.

RESULTS

Most participants acknowledged the importance and usefulness of assessing understanding of pain concepts but anticipated patients' difficulty comprehending items assessing biological mechanisms underlying pain. Participants questioned the items' accuracy, indicating their limited pain knowledge and the necessity of reducing literacy demands. The critical domains of pain education were learning about pain, external factors influencing pain, and pain as a form of protection.

CONCLUSION

Participants had suboptimal pain knowledge but emphasized decreasing literacy demands of pain neurophysiology items. Additionally, it is necessary to develop and implement a pain education program to improve pain-related knowledge and provide educational content for healthcare professionals encountering patients in pain.

Sex-specific effects of neuropathic pain on long-term pain behavior and mortality in mice

ABSTRACT

Human epidemiological studies suggest that chronic pain can increase mortality risk. We investigated whether this was true in mice so that underlying mechanisms might be identified. At 10 weeks of age, C57BL/6 mice of both sexes received sham or spared nerve injury (SNI) surgery producing neuropathic pain. Mice were weighed monthly, tested behaviorally for mechanical and cold sensitivity and guarding behavior every 3 months postsurgery, and otherwise left undisturbed in their cages until death by natural causes. Evidence of pain over the lifespan displayed a strikingly sex-specific pattern. Male mice displayed largely stable mechanical and cold hypersensitivity and guarding at 6 to 30 months post-SNI. By contrast, female mice displayed a biphasic temporal pattern of mechanical hypersensitivity and guarding behavior, with a complete resolution of SNI-induced pain behavior at 6 to 9 months post-SNI followed by the return of pain thereafter. Mouse lifespan was not significantly altered by SNI in either sex nor was frailty as assessed by cage inspection in the last 6 months of life. However, in male mice with SNI, we observe a significant correlation between average lifetime mechanical hypersensitivity and lifespan, such that death occurred sooner in male mice exhibiting more evidence of chronic pain. This relationship was not observed in female SNI mice nor in sham-operated mice of either sex. This experiment is the first to investigate pain behavior over an entire adult lifetime and suggests that biology of relevance to human chronic pain is being ignored by the very short timespans of most extant preclinical pain research.