Background & Aims
Associations between psychosocial factors and the experience of chronic pain are well-established in general adult populations [2; 3]. However, evidence suggests that psychosocial correlates of pain differ in older (vs. younger) adults [1; 5; 6; 9]. Moreover, the COVID-19 pandemic was associated with numerous psychosocial effects (e.g., higher rates of anxiety/depression, social isolation, loneliness [4; 7; 10]), that are known risk factors for chronic pain in older adults [8]. To inform the development and refinement of psychosocial interventions to manage chronic pain in older adults, it is important to obtain up-to-date information on associations between psychosocial factors and chronic pain in this specific population. The goal of these analyses was to evaluate for differences in psychological and social factors as a function of chronic pain status and severity in a nationally representative sample of older adults in the United States (U.S.) in 2022.
Methods
A nationally representative sample of 2,038 U.S. older adults (aged ?65) was recruited from NORC at the University of Chicago’s AmeriSpeak® Panel. A single-item chronic pain screener was used to identify participants with chronic pain (defined as pain on more than half the days in the past 3 months). Among those with chronic pain, pain severity was assessed using the PEG scale, which measures pain intensity (P), interference with enjoyment of life (E), and interference with general activity (G). Participants completed measures of psychosocial constructs, including depression (Patient Health Questionnaire – 8 item), anxiety (Generalized Anxiety Disorder -7 item), social support (Medical Outcomes Study Social Support Scale), and loneliness (UCLA Loneliness Scale). SAS 9.4 (SAS Institute, Inc, Cary, NC) was used to evaluate for associations between chronic pain status/severity and psychosocial constructs.
Results
Older adults with (vs. without) chronic pain scored higher on measures of depression and anxiety (p <.05). Among older adults with chronic pain, pain severity was positively associated with depression and anxiety symptoms (p <.05). Although no differences in social support were found between those with (vs. without) chronic pain, older adults with chronic pain reported feeling lonelier than those without chronic pain (p <.05). Among older adults with chronic pain, higher pain severity was associated with less social support and more loneliness (p < .01). Specifically, higher pain severity was associated with less instrumental and emotional support. Moreover, each point increase in PEG total score was associated with a 27% increased likelihood of being lonely (OR = 1.27, 95% CI: 1.2-1.4). This pattern of findings remained the same even after controlling for relevant sociodemographic factors (i.e., gender, age, race/ethnicity, employment status, income).
Conclusions
Older adults with chronic pain reported greater depression and anxiety symptoms and felt lonelier than those without chronic pain. Moreover, among older adults with chronic pain, greater pain severity was associated with more anxiety, depression, and loneliness, and less social support. Although additional research is needed to evaluate for longitudinal differences in psychosocial factors and chronic pain outcomes, the current results underscore the importance of assessing and addressing psychosocial risk factors in older adults.
References
[1] Boggero IA, Rojas Ramirez MV, King CD. Cross-sectional associations of fatigue subtypes with pain interference in younger, middle-aged, and older adults with chronic orofacial pain. Pain Med 2020;21(9):1961-1970.
[2] Edwards RR, Dworkin RH, Sullivan MD, Turk DC, Wasan AD. The role of psychosocial processes in the development and maintenance of chronic pain. J Pain 2016;17(9):T70-T92.
[3] Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Associations between psychosocial factors and pain intensity, physical functioning, and psychological functioning in patients with chronic pain: a cross-cultural comparison. Clin J Pain 2014;30(8):713-723.
[4] Gosselin P, Castonguay C, Goyette M, Lambert R, Brisson M, Landreville P, Grenier S. Anxiety among older adults during the COVID-19 pandemic. J Anxiety Disord 2022;92:102633.
[5] Honda M, Iida T, Komiyama O, Masuda M, Uchida T, Nishimura H, Okubo M, Shimosaka M, Narita N, Niwa H. Characteristics of middle-aged and older patients with temporomandibular disorders and burning mouth syndrome. J Oral Sci 2015;57(4):355-360.
[6] Ji L, Qiao X, Jin Y, Si H, Liu X, Wang C. “Age-related positivity effect” in the relationship between pain and depression among Chinese community-dwelling older adults: Sex differences. Pain Manag Nurs 2021;22(6):747-754.
[7] Lebrasseur A, Fortin-Bédard N, Lettre J, Raymond E, Bussières E-L, Lapierre N, Faieta J, Vincent C, Duchesne L, Ouellet M-C. Impact of the COVID-19 pandemic on older adults: Rapid review. JMIR Aging 2021;4(2):e26474.
[8] Miaskowski C, Blyth F, Nicosia F, Haan M, Keefe F, Smith A, Ritchie C. A biopsychosocial model of chronic pain for older adults. Pain Med 2020;21(9):1793-1805.
[9] Murray CB, Patel KV, Twiddy H, Sturgeon JA, Palermo TM. Age differences in cognitive–affective processes in adults with chronic pain. Eur J Pain 2021;25(5):1041-1052.
[10] Wu B. Social isolation and loneliness among older adults in the context of COVID-19: A global challenge. Glob Health Res Policy 2020;5(1):27.
Presenting Author
Christine Ritchie
Poster Authors
Topics
- Epidemiology