Persistent Pain Quality as a Novel Approach to Assessing Risk for Disability in Community-Dwelling Elders With Chronic Pain

6627 Background: Few studies have evaluated the epidemiology of breakthrough pain (BTP) in community-dwelling populations with cancer and chronic pain. The National Breakthrough Pain Survey (NBTPS) assessed the prevalence, characteristics, and impact of BTP in a large commercially-insured population and determined the BTP-associated functional impairments and disability in cancer patients with controlled, persistent pain. Methods: Administrative claims from the HealthCore Integrated Research Database were utilized to identify commercially-insured adult patients with ≥2 medical claims at an interval ≥3 months with an ICD-9-CM code indicating a chronic pain condition (cancer or noncancer) and ≥3 opioid prescription claims. Patients were called and, after consent, completed the Brief Pain Inventory (BPI), Sheehan Disability Scale (SDS), and 12-Item Short-Form Health Survey (SF-12) by interview. Data from patients with cancer and controlled, persistent pain were included in this subanalysis. Results: Of 2198 patients surveyed, 1279 had controlled, persistent pain. Of these, 145 had cancer pain, 77.2% of whom reported BTP (BTP, 112; no BTP, 33). Compared to those without BTP, cancer patients with BTP had significantly higher total BPI pain interference scores (mean±SD 34.7±14.5 vs 23.4±16.7, P=.001) and significantly greater global functional impairment on the SDS (mean±SD 16.8±8.3 vs 12.4±8.3, P=.028). There also was a non-significant finding of decreased quality of life, as assessed by SF-12 physical and mental component scale scores, among cancer patients with BTP vs no BTP (mean±SD 27.8±9.1 vs 32.2±10.1, P=.11, and 47.0±11.9 vs 49.4±11.6, P=1.0, respectively). Conclusions: In a sample of commercially-insured patients, cancer patients with controlled, persistent pain and BTP had greater pain-related functional impairments and disability than those with controlled, persistent pain and no BTP. These data suggest that BTP is clinically important among populations receiving cancer care in the community.

Download Full-text

Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan

Healthcare ◽

10.3390/healthcare9060630 ◽

2021 ◽

Vol 9 (6) ◽

pp. 630

Author(s):

Satoshi Shimo ◽

Yuta Sakamoto ◽

Takashi Amari ◽

Masaaki Chino ◽

Rie Sakamoto ◽

...

Keyword(s):

Chronic Pain ◽

Elderly People ◽

Physical Disability ◽

The Elderly ◽

Daily Basis ◽

Community Dwelling ◽

Negative Effects ◽

The Relationship ◽

Elderly Healthcare ◽

Disability Research

Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.

Download Full-text

What do Community-dwelling Older Adults with Chronic Pain Value in a Program of Combined Pain Neuroscience Education plus Exercise?

Patient Education and Counseling ◽

10.1016/j.pec.2021.04.017 ◽

2021 ◽

Author(s):

Emanuel Heleno ◽

Rosa Andias ◽

Anabela G Silva

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Community Dwelling ◽

Neuroscience Education ◽

Community Dwelling Older Adults

Download Full-text

Are all Older Adults with Persistent Pain Created Equal? Preliminary Evidence for a Multiaxial Taxonomy

Pain Research and Management ◽

10.1155/2001/602345 ◽

2001 ◽

Vol 6 (3) ◽

pp. 133-141 ◽

Cited By ~ 12

Author(s):

Debra K Weiner ◽

Thomas E Rudy ◽

Swati Gaur

Keyword(s):

Older Adults ◽

Activities Of Daily Living ◽

Daily Living ◽

Preliminary Evidence ◽

Persistent Pain ◽

Community Dwelling ◽

Pain Clinic ◽

Response To Treatment ◽

Sleep Disruption ◽

Activity Levels

BACKGROUND: Persistent pain is grossly undertreated in older adult sufferers, despite its high prevalence in this age group. Because of its multidimensional impacts, including depression, sleep disruption and physical disability, patients with persistent pain often benefit from interdisciplinary pain clinic treatment. This treatment is expensive, however, and may not be required by all patients. The Multiaxial Assessment of Pain (MAP) has demonstrated value in predicting response to treatment in younger adults with persistent pain.OBJECTIVE: To examine the feasibility of a MAP taxonomy for community-dwelling adults age 65 years or older.PARTICIPANTS AND PROCEDURES: One hundred eight subjects with persistent pain (mean age 73.8 years, SD=8.4 years) were interviewed and data collected on demographics, pain intensity, depressive symptoms, sleep disruption, pain interference with performance of basic and instrumental activities of daily living, frequency of engagement in advanced activities of daily living, cognitive function and comorbidity. A subset of these subjects underwent physical capacities testing, including maximal isometric lift strength, dynamic lifting endurance, timed chair rise and balance.RESULTS: Analyses derived three primary clusters of patients. Cluster 1 (24%) reported less intense pain, less depression and sleep disruption, and higher activity levels. Cluster 3 (30%) suffered from more pain and were more functionally disabled. Cluster 2 (46%) had characteristics of cluster 1 and cluster 3, but with some characteristics that were clearly unique.CONCLUSIONS: While these results are preliminary and require further validation, they indicate that older adults are heterogeneous in their response to persistent pain. Future studies should be performed to examine whether the MAP taxonomy is applicable to older adults regardless of medical diagnosis. Ultimately, this information may have meaning with regard to both treatment prescribing, and the design and interpretation of intervention studies.

Download Full-text

F283 MULTISENSORY STIMULATION AND EXERCISE PROGRAMME FOR COMMUNITY-DWELLING OLDER PERSONS WITH CHRONIC PAIN

European Journal of Pain Supplements ◽

10.1016/s1754-3207(11)70508-9 ◽

2011 ◽

Vol 5 (S1) ◽

pp. 148-148

Author(s):

M. Tse

Keyword(s):

Chronic Pain ◽

Older Persons ◽

Exercise Programme ◽

Community Dwelling ◽

Multisensory Stimulation

Download Full-text

Persistence of Noncancer-related Musculoskeletal Chronic Pain Among Community-dwelling Older People

Clinical Journal of Pain ◽

10.1097/ajp.0000000000000089 ◽

2015 ◽

Vol 31 (1) ◽

pp. 79-85 ◽

Cited By ~ 12

Author(s):

Niina M. Karttunen ◽

Juha H. O. Turunen ◽

Riitta S. Ahonen ◽

Sirpa A. Hartikainen

Keyword(s):

Chronic Pain ◽

Older People ◽

Community Dwelling ◽

Community Dwelling Older People

Download Full-text

The Situated Influence of Chronic Pain Perception on Chinese Older Adults’ Self-Management in Home Care

Geriatrics ◽

10.3390/geriatrics3040064 ◽

2018 ◽

Vol 3 (4) ◽

pp. 64

Author(s):

Fang Liu ◽

Min Tong

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Chronic Disease ◽

Pain Perception ◽

Community Dwelling ◽

Self Management ◽

Chinese Older Adults ◽

Care Experience ◽

Management Capacity ◽

Important Others

Background and objective: Worldwide, 26 million older adults die from chronic disease, and chronic pain is typically a part of the experience of chronic disease. This study explores the perception of chronic pain for home-dwelling Chinese older adults and its influence on (1) self-management ability and (2) management and reduction of chronic pain. Methods: Adopting a qualitative study design, we conducted in-depth interviews with 10 Chinese community-dwelling older adults who experience chronic pain. Half of our informants perceive chronic pain, whereas the other half, diagnosed with Alzheimer’s disease, do not report that they perceive chronic pain. Data were analyzed with inductive thematic analysis. Results: Chronic pain perception plays important roles in (1) defining the challenge of self-management, (2) connecting previous caretaking experience, (3) adjusting the identity of self-management, (4) acquiring support from important others and (5) re-planning self-management arrangements. Conclusion: Pain perception helps to motivate Chinese older adults to face health challenges and regain self-management capacity through adjustments in self-identity and care experience with the support of important others. Pain perception can consolidate the situation of independent living of older adults. It helps to motivate Chinese older adults to face health challenges and regain self-management capacity.

Download Full-text

Daily Physical Activity and Functional Disability Incidence in Community-Dwelling Older Adults with Chronic Pain: A Prospective Cohort Study

Pain Medicine ◽

10.1093/pm/pny263 ◽

2018 ◽

Vol 20 (9) ◽

pp. 1702-1710 ◽

Cited By ~ 4

Author(s):

Keitaro Makino ◽

Sangyoon Lee ◽

Sungchul Lee ◽

Seongryu Bae ◽

Songee Jung ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Chronic Pain ◽

Functional Disability ◽

Community Dwelling ◽

Daily Physical Activity ◽

Activity Duration ◽

Intensity Physical Activity ◽

Physical Activity Duration ◽

Community Dwelling Older Adults

Abstract Objective This study examined the association between daily physical activity and functional disability incidence in community-dwelling older adults with chronic pain. Design Prospective cohort study. Setting Japanese community. Subjects Of the 5,257 participants enrolled for baseline assessment, data on the 693 participants who had chronic lower back or knee pain and underwent daily physical activity assessment using an accelerometer were analyzed. Methods Participants were assessed for regular physical activity (step counts, moderate- to vigorous-intensity physical activity duration, and light-intensity physical activity duration) using an accelerometer at baseline and were followed up for monthly functional disability incidence, based on the national long-term care insurance system, for approximately two years. We determined the effect of physical activity cutoff points on functional disability incidence using receiver operating characteristic curves and Youden index. Cox proportional hazards regression models were used to analyze associations between the cutoff points and disability incidence. Results Among the 693 participants with chronic pain, 69 (10.0%) developed functional disability during the follow-up period. Participants with lower physical activity levels showed significantly higher risk of disability. After adjusting for all covariates, functional disability was associated with step counts (hazard ratio [HR] = 1.79, 95% confidence interval [CI] = 1.02–3.14) and moderate- to vigorous-intensity physical activity duration (HR = 2.02, 95% CI = 1.16–3.51) but had no relationship with light-intensity physical activity duration (HR = 1.72, 95% CI = 0.97–3.05). Conclusions Maintenance of physical activity with at least moderate intensity may be effective in preventing disability even among older adults with chronic pain.

Download Full-text