Pain and mortality in older adults: The influence of pain phenotype

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SCIENCE
Pain and mortality in older adults: The influence of pain phenotype
Key Take-Away: 

Pain is a common concern among older (≥65 years) individuals, and it has been associated with disability, reduced mobility, fewer activities, falls, depression, anxiety and sleep impairment. In this study, the association between pain and increased risk of mortality has been defined.

Moderate to severe chronic pain affects one in five adults. Pain may increase the risk of mortality but the relationship is unclear. 

ABSTRACT: 
Background: 

Moderate to severe chronic pain affects one in five adults. Pain may increase the risk of mortality but the relationship is unclear.

This study investigated whether mortality risk was influenced by pain phenotype, characterized by pain extent or pain impact on daily life.

Methods: 

The study population was drawn from two large population cohorts of adults aged ≥50 years; the English Longitudinal Study of Ageing (ELSA) (n=6324) and the North Staffordshire Osteoarthritis Project (NorStOP) (n=10985).

Survival analyses (Cox's proportional hazard models) estimated the risk of mortality in participants reporting "any pain" and then separately according to the extent of pain (total number of pain sites; widespread pain according to American College of Rheumatology (ACR) criteria; widespread pain according to Manchester criteria) and pain impact on daily life (pain interference; and often troubled with pain). Models were cumulatively adjusted for age, sex, education and wealth/adequacy of income.

Results: 

After adjustments, the report of any pain (MRR 1.06, 95% CI (0.95, 1.19)) or having widespread pain (ACR 1.07 (0.92, 1.23) or Manchester 1.16 (0.99, 1.36)) was not associated with an increased risk of mortality.

Participants who were often troubled with pain (1.29 (1.12, 1.49)) and those that reported "quite a bit" (1.38 (1.20,1.59)) and "extreme" (1.88 (1.54, 2.29)) pain interference had an increased risk of all-cause mortality.

Conclusion: 

Pain that interferes with daily life, rather than pain per se was associated with an increased risk of mortality.

Future studies should investigate the mechanisms through which pain increases mortality risk.

Arthritis Care Res (Hoboken). 2017 Jun 7
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