Background & Aims
The high prevalence of chronic pain (34?39%) in older adults is expected to increase given the growth of the population(1-4). Although the studies about chronic pain in older adults are limited, they show that the relationship between chronic pain and physical and cognitive decline may be bidirectional(3).
Due to the exacerbation of pain after some exercise/routine life activities, many older adults avoid activities that could contribute to pain(5-6). The coupling of pain and activity avoidance in pain syndromes accelerates functional decline(7). Likewise, neural systems involved in memory and cognition are linked to those involved in pain processing and thus these systems may affect one another, disrupting cognitive processing and contributing to a downward spiral of continuing pain, adverse neurostructural changes, and deteriorating cognitive function(3,8).
The objective was to compare motor and cognitive functions in community-dwelling older adults with and without chronic pain.
Methods
This is an observational cross-sectional study. Community-dwelling older adults from Petrolina-PE (Brazil) of both sexes and >60 years old were recruited. They should not have a history of serious cardiovascular disease, severe cognitive impairment, or neuromuscular diseases. Chronic pain was considered present if they had pain for >3 months(9).
Global cognition was assessed using the Montreal Cognitive Assessment (MoCA)(10), which total score ranges from 0-30 points, while higher values indicate better global cognitive function. One point was added for participants with <12 years of education. The Short Physical Performance Battery (SPPB) was used to combine data from gait speed, static balance, and lower limb strength. Its total score varies from 0- 12 points(11).
The subgroups with and without chronic pain were compared regarding age, body mass index (BMI), global cognition, and mobility using the Mean Difference (MD) and the 95% confidence interval (CI) of the difference.
Results
Sixty-four older adults (14 men, 50 women) were included, with an average age of 69.8±5.6 years and a BMI of 24.4±4.1 kg/m2. Thirty-seven subjects presented chronic pain with median maximum pain of 3 (0-10), minimum pain of 0 (0-7), average pain of 5 (0-10), and current pain of 0 (0-8).
Older adults with pain scored an average of 20.4±4.3 at MoCA, while the ones with no pain scored 22.7±3.9. The total score for the SPPB was 9.1±2.9 for the older adults with pain, and 10.58±1.5 for the ones with no pain.
The groups of older adults with and without pain were similar regarding sex distribution, age (MD of -1.92 years, 95%CI of -4.8; 0.9), BMI (MD of -1,37 kg/m2, 95%CI of -3.4; 0.7), and global cognition (MD of 1.9 points, 95% CI of -0.2; 4.90). However, the older adults without pain showed higher mobility scores according to the SPPB (MD of 1.5 points, 95% CI of 0.2; 2.7) compared to the group with pain.
Conclusions
Older adults with pain showed less mobility according to the SPPB, which indicates that gait speed, static balance, and lower limb strength are decreased in this population, when compared to older adults with the same age, BMI, and global cognition.
References
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2.Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults – United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67(36):1001–1006.
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4.Sun M, Yu B, Zhang X, et al. Trends in multimorbidity of multiple noncommunicable diseases among adults in the United States, 1999–2016. SSRN Electronic Journal 2019. 10.2139/ssrn.3433889.
5.Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med 2017;177(8):1146–1153.
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7.Quicke JG, Foster NE, Ogollah RO, Croft PR, Holden MA. Relationship Between Attitudes and Beliefs and Physical Activity in Older Adults With Knee Pain: Secondary Analysis of a Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017;69(8):1192–1200.
8.Moriarty O, McGuire BE, Finn DP. The effect of pain on cognitive function: a review of clinical and preclinical research. Prog Neurobiol 2011;93(3):385–404.
9.IASP announces revised definition of pain International Association for the Study of Pain (IASP). https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/. Published July 20, 2021.
10.Memória CM, Yassuda MS, Nakano EY, Forlenza OV. Brief screening for mild cognitive impairment: validation of the Brazilian version of the Montreal cognitive assessment. Int J Geriatr Psychiatry. 2013 Jan;28(1):34-40.
11.Vasunilashorn S, Coppin AK, Patel KV, Lauretani F, Ferrucci L, Bandinelli S, Guralnik JM. Use of the Short Physical Performance Battery Score to predict loss of ability to walk 400 meters: analysis from the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2009 Feb;64(2):223-9.
Presenting Author
Luiz Felipe Tavarez
Poster Authors
Letícia Calixtre
PhD. PT.
Universidade de Pernambuco - Campus Petrolina
Lead Author
Laisla Paixão
Universidade de Pernambuco, Campus Petrolina, Brazil.
Lead Author
Jaqueline Silva Sousa
Universidade de Pernambuco, Campus Petrolina, Brazil.
Lead Author
Julia Castro
Universidade de Pernambuco, Campus Petrolina, Brazil.
Lead Author
Luiz Felipe Tavarez
Universidade Federal de São Carlos - Brazil
Lead Author
Rodrigo Cappato de Araújo
Universidade de Pernambuco, Campus Petrolina, Brazil.
Lead Author
Topics
- Pain in Special Populations: Elderly