The Effect of Obesity on Pain Severity and Pain Interference

ABSTRACTBackground and objectivesObesity is one of the most prevalent comorbidities associated with chronic pain, the experience of which can severely interfere with activities of daily living and increase the utilization of clinical resources. Obesity is also a risk factor for increased pain severity (pain intensity) and pain interference (pain related disability). We hypothesize that a higher level of obesity, as measured by body mass index (BMI), would be associated with increased levels of pain severity and interference in a population of chronic pain clinic patients.MethodsParticipant data was pulled from a multi-site chronic pain outpatient database from 7/8/2011 to 10/17/2016. The Brief Pain Inventory (BPI), opioid prescriptions, and basic demographic information were queried and we categorized participants into three different ordinal categories based on recorded BMI levels (underweight, normal and overweight, obese). Bivariate analyses were performed to compare pain outcomes by BMI and by other demographic/clinical patient characteristics. Multivariable linear regressions were constructed to model each of four pain severity scores in addition to total pain interference score. All models examined BMI as the primary predictor, controlling for age, receipt of a pain procedure within 45 days prior to the pain clinic encounter, opioid prescription within 45 days prior to the encounter, and diagnosis. The total pain interference model additionally included pain severity (as measured by worst pain in the past 24 hours) as a covariate.Results2509 patients were included in the study. The median BMI was 27 and the median age was 59 years. 77% of patients were diagnosed with musculoskeletal pain conditions. Bivariate tests revealed significant differences between BMI groups for all pain severity scores and for total pain interference score. On multivariable modelling controlling for age, pain procedure within 45 days prior to pain clinic encounter, opioid prescription with 45 days prior, and diagnosis, obese patients had significantly higher pain severity (as measured by worst, least, average, and current pain in the past 24 hours) as well as higher pain interference (as measured by the overall pain interference score) than normal weight and overweight patients.ConclusionIn our study of pain clinic patients, obesity was found to be associated with increased pain severity and pain interference. We believe that this relationship is multifactorial and bidirectional. Pain phyisicans should consider the impact of obesity when addressing pain management for patients.

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The effect of obesity on pain severity and pain interference

Pain Management ◽

10.2217/pmt-2020-0089 ◽

2021 ◽

Author(s):

Jade I Basem ◽

Robert S White ◽

Stephanie A Chen ◽

Elizabeth Mauer ◽

Michele L Steinkamp ◽

...

Keyword(s):

Chronic Pain ◽

Daily Living ◽

Normal Weight ◽

Pain Severity ◽

Pain Interference ◽

Obese Patients ◽

Total Pain ◽

Severity Scores ◽

Average Current ◽

Interference Score

Aim: Obesity is one of the most prevalent comorbidities associated with chronic pain, which can severely interfere with daily living and increase utilization of clinical resources. We hypothesized that a higher level of obesity, measured by BMI, would be associated with increased pain severity (intensity) and interference (pain related disability). Materials & methods: Participant data was pulled from a multisite chronic pain outpatient database and categorized based on BMI. Results: A total of 2509 patients were included in the study. We found significant differences between BMI groups for all pain severity scores (worst, least, average, current) and total pain interference score. Obese patients had significantly higher scores than normal weight patients. Conclusion: We found obesity to be associated with increased pain severity and pain interference.

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Central Sensitization in Neurological, Psychiatric, and Pain Disorders: A Multicenter Case-Controlled Study

Pain Research and Management ◽

10.1155/2021/6656917 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Keisuke Suzuki ◽

Yasuo Haruyama ◽

Gen Kobashi ◽

Toshimi Sairenchi ◽

Koji Uchiyama ◽

...

Keyword(s):

Depressive Symptoms ◽

Central Sensitization ◽

Pain Severity ◽

Pain Interference ◽

Daily Activities ◽

Effect Sizes ◽

Medium Effect ◽

Controlled Study ◽

Severity Scores ◽

The Impact

Background. The role of central sensitization in refractory pain-related diseases has not yet been clarified. Methods. We performed a multicenter case-controlled study including 551 patients with various neurological, psychological, and pain disorders and 5,188 healthy controls to investigate the impact of central sensitization in these patients. Symptoms related to central sensitization syndrome (CSS) were assessed by the Central Sensitization Inventory (CSI) parts A and B. Patients were categorized into 5 groups based on CSI-A scores from subclinical to extreme. The Brief Pain Inventory (BPI), addressing pain severity and pain interference with daily activities, and the Patient Health Questionnaire (PHQ)-9, assessing depressive symptoms, were also administered. Results. CSI-A scores and CSI-B disease numbers were significantly greater in patients than in controls ( p < 0.001 ). Medium effect sizes (r = 0.37) for CSI-A scores and large effect sizes (r = 0.64) for CSI-B disease numbers were found between patients and control groups. Compared with the CSI-A subclinical group, the CSI-A mild, moderate, severe, and extreme groups had significantly higher BPI pain interference and severity scores, PHQ-9 scores, and CSS-related disease numbers based on ANCOVA. Greater CSI-B numbers resulted in higher CSI-A scores ( p < 0.001 ) and a higher odds ratio ( p for trend <0.001). CSS-related symptoms were associated with pain severity, pain interference with daily activities, and depressive symptoms in various pain-related diseases. Conclusions. Our findings suggest that CSS may participate in these conditions as common pathophysiology.

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Empathic Accuracy in Chronic Pain: Exploring Patient and Informal Caregiver Differences and Their Personality Correlates

Medicina ◽

10.3390/medicina55090539 ◽

2019 ◽

Vol 55 (9) ◽

pp. 539

Author(s):

Suso-Ribera ◽

Martínez-Borba ◽

Viciano ◽

Cano-García ◽

García-Palacios

Keyword(s):

Chronic Pain ◽

Social Factors ◽

Informal Caregiver ◽

Informal Caregivers ◽

Empathic Accuracy ◽

Pain Interference ◽

Pain Clinic ◽

Accurate Estimation ◽

The Impact ◽

Pain Patients

Background and objectives: Social factors have demonstrated to affect pain intensity and quality of life of pain patients, such as social support or the attitudes and responses of the main informal caregiver. Similarly, pain has negative consequences on the patient’s social environment. However, it is still rare to include social factors in pain research and treatment. This study compares patient and caregivers’ accuracy, as well as explores personality and health correlates of empathic accuracy in patients and caregivers. Materials and Methods: The study comprised 292 chronic pain patients from the Pain Clinic of the Vall d’Hebron Hospital in Spain (main age = 59.4 years; 66.8% females) and their main informal caregivers (main age = 53.5 years; 51.0% females; 68.5% couples). Results: Patients were relatively inaccurate at estimating the interference of pain on their counterparts (t = 2.16; p = 0.032), while informal caregivers estimated well the patient’s status (all differences p > 0.05). Empathic accuracy on patient and caregiver status did not differ across types of relationship (i.e., couple or other; all differences p > 0.05). Sex differences in estimation only occurred for disagreement in pain severity, with female caregivers showing higher overestimation (t = 2.18; p = 0.030). Patients’ health status and caregivers’ personality were significant correlates of empathic accuracy. Overall, estimation was poorer when patients presented higher physical functioning. Similarly, caregiver had more difficulties in estimating the patient’s pain interference as patient general and mental health increased (r = 0.16, p = 0.008, and r = 0.15, p = 0.009, respectively). Caregiver openness was linked to a more accurate estimation of a patient’s status (r = 0.20, p < 0.001), while caregiver agreeableness was related to a patient’s greater accuracy of their caregivers’ pain interference (r = 0.15, p = 0.009). Conclusions: Patients poorly estimate the impact of their illness compared to caregivers, regardless of their relationship. Some personality characteristics in the caregiver and health outcomes in the patient are associated with empathic inaccuracy, which should guide clinicians when selecting who requires more active training on empathy in pain settings.

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CHRONIC PAIN, FEAR OF FALLING, AND RESTRICTED ACTIVITY DAYS IN AN OLDER POPULATION

Innovation in Aging ◽

10.1093/geroni/igz038.066 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S18-S18

Author(s):

Suzanne Leveille

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Fall Risk ◽

Fear Of Falling ◽

Pain Severity ◽

Pain Interference ◽

Multisite Pain ◽

Restricted Activity ◽

Pain Characteristics ◽

The Impact

Abstract Both chronic pain and fear of falling can lead to activity restriction and increased fall risk among vulnerable elders. Little is known about pain characteristics that may be associated with fear of falling, contributing to restricted activity. We studied 765 adults aged ≥65y (mean=78.9y) in the MOBILIZE Boston Study, to evaluate the cross-sectional relationship between pain characteristics and fear of falling measured using the Falls Efficacy Scale (FES). In addition, we examined the impact of pain and fear of falling on restricted activity. We measured 3 domains of global pain: pain distribution (none, single site or multisite pain), and Brief Pain Inventory subscales of pain severity and pain interference. Restricted activity days (RADs) refer to the count of self-reported days of reduced activity due to illness or injury in the previous 12 months. We performed multivariable logistic regressions predicting fear of falling (FES<90/100) adjusted for sociodemographics, fall history and fall risk factors. Participants with multisite pain or moderate-to-high pain interference ratings were more likely to have fear of falling (adj.OR 1.97, 95%CI 1.05-3.67; adj.OR 4.02, 95%CI 2.0-8.06, respectively). Pain severity was not associated with FES. Older adults with multisite pain and fear of falling reported significantly more RADs than those with multisite pain without fear of falling (79±135 and 26±74 RADs, respectively; test for pain x FES interaction, p=0.01). Older adults with chronic pain have greater fear of falling which may contribute to restricted activity. Efforts are needed to increase activity and falls efficacy among older adults with chronic pain.

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Exploring perceptions and experiences of patients who have chronic pain as state prescription opioid policies change: a qualitative study in Indiana

BMJ Open ◽

10.1136/bmjopen-2016-015083 ◽

2017 ◽

Vol 7 (11) ◽

pp. e015083 ◽

Cited By ~ 3

Author(s):

Morhaf Al Achkar ◽

Debra Revere ◽

Barbara Dennis ◽

Palmer MacKie ◽

Sumedha Gupta ◽

...

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Pain Management ◽

Qualitative Study ◽

Inappropriate Prescribing ◽

Primary Care Providers ◽

Pain Clinic ◽

Care Providers ◽

Opioid Prescription ◽

The Impact

ObjectivesThe misuse and abuse of prescription opioids (POs) is an epidemic in the USA today. Many states have implemented legislation to curb the use of POs resulting from inappropriate prescribing. Indiana legislated opioid prescribing rules that went into effect in December 2013. The rules changed how chronic pain is managed by healthcare providers. This qualitative study aims to evaluate the impact of Indiana’s opioid prescription legislation on the patient experiences around pain management.SettingThis is a qualitative study using interviews of patient and primary care providers to obtain triangulated data sources. The patients were recruited from an integrated pain clinic to which chronic pain patients were referred from federally qualified health clinics (FQHCs). The primacy care providers were recruited from the same FQHCs. The study used inductive, emergent thematic analysis.ParticipantsNine patient participants and five primary care providers were included in the study.ResultsLiving with chronic pain is disruptive to patients’ lives on multiple dimensions. The established pain management practices were disrupted by the change in prescription rules. Patient–provider relationships, which involve power dynamics and decision making, shifted significantly in parallel to the rule change.ConclusionsAs a result of the changes in pain management practice, some patients experienced significant challenges. Further studies into the magnitude of this change are necessary. In addition, exploring methods for regulating prescribing while assuring adequate access to pain management is crucial.

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The Impact of Enrollment in a Specialized Interdisciplinary Neuropathic Pain Clinic

Pain Research and Management ◽

10.1155/2011/518710 ◽

2011 ◽

Vol 16 (3) ◽

pp. 159-168 ◽

Cited By ~ 6

Author(s):

Alex Garven ◽

Shauna Brady ◽

Susan Wood ◽

Melinda Hatfield ◽

Jennifer Bestard ◽

...

Keyword(s):

Quality Of Life ◽

Health Care ◽

Chronic Pain ◽

Neuropathic Pain ◽

Diagnostic Evaluation ◽

Pain Severity ◽

Pain Clinic ◽

Pain Clinics ◽

The Impact

BACKGROUND: Chronic pain clinics have been created because of the increasing recognition of chronic pain as a very common, debilitating condition that requires specialized care. Neuropathic pain (NeP) is a multifaceted, specialized form of chronic pain that often requires input from multiple disciplines for assessment and management.OBJECTIVE: To determine the impact of an interdisciplinary clinic for evaluation and treatment of patients with NeP.METHODS: Patients with heterogeneous etiologies for NeP were prospectively evaluated using an interdisciplinary approach every six months. Diagnostic evaluation, comorbidity evaluation, education, and pharmacological and/or nonpharmacological management were completed. Severity (visual analogue scale) and features of pain (Modified Brief Pain Inventory), sleep difficulties (Medical Outcomes Study – Sleep Scale), mood/anxiety disruption (Hospital Anxiety and Depression Scale), quality of life (European Quality-of-Life Five-Domain index), health care resources use, patient satisfaction (Pain Treatment Satisfaction Scale and Neuropathic Pain Symptom Inventory) and self-perceived change in well-being (Patient Global Impression of Change scale) were examined at each visit.RESULTS: Pain severity only decreased after one year of follow-up, while anxiety and quality-of-life indexes improved after six months. Moderate improvements of sleep disturbance, less frequent medication use and reduced health care resource use were observed during enrollment at the NeP clinic.DISCUSSION: Despite the limitations of performing a real-world, uncontrolled study, patients with NeP benefit from enrollment in a small interdisciplinary clinic. Education and a complete diagnostic evaluation are hypothesized to lead to improvements in anxiety and, subsequently, pain severity. Questions remain regarding the long-term maintenance of these improvements and the optimal structure of specialized pain clinics.

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Evaluating the Relationship Between Initial Injury, Referral to A Pain Clinic, and Medical Retirement from the Army: A Retrospective Analysis

Military Medicine ◽

10.1093/milmed/usaa463 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 502-505

Author(s):

Justin J Stewart ◽

Diane Flynn ◽

Alana D Steffen ◽

Dale Langford ◽

Honor McQuinn ◽

...

Keyword(s):

Chronic Pain ◽

Retrospective Analysis ◽

Extended Period ◽

Pain Clinic ◽

Outcome Variable ◽

Future Research ◽

Curvilinear Relationship ◽

The Impact ◽

Pain Care ◽

The Relationship

ABSTRACT Introduction Soldiers are expected to deploy worldwide and must be medically ready in order to accomplish their mission. Soldiers unable to deploy for an extended period of time because of chronic pain or other conditions undergo an evaluation for medical retirement. A retrospective analysis of existing longitudinal data from an Interdisciplinary Pain Management Center (IPMC) was used to evaluate the temporal relationship between the time of initial duty restriction and referral for comprehensive pain care to being evaluated for medical retirement. Methods Patients were adults (>18 years old) and were cared for in an IPMC at least once between May 1, 2014 and February 28, 2018. A total of 1,764 patients were included in the final analysis. Logistic regression was used to evaluate the impact of duration between date of first duty restriction documentation and IPMC referral to the outcome variable of establishment of a permanent 3 (P3) profile. Results The duration between date of first duty restriction and IPMC referral showed a curvilinear relationship to probability of a P3 profile. According to our model, a longer duration before referral is associated with an increased probability of a subsequent P3 profile with the highest probability peaking at 19 months. The probability of P3 declines gradually for those who were referred later. Discussion This is the first time the relationship between time of initial duty restriction, referral to an IPMC, and subsequent P3 or higher profile has been tested. Future research is needed to examine medical conditions listed on the profile to see how they might contribute to the cause of referral to the IPMC. Conclusion A longer duration between initial duty restriction and referral to IPMC was associated with higher odds of subsequent P3 status for up to 19 months. Referral to an IPMC for comprehensive pain care early in the course of chronic pain conditions may reduce the likelihood of P3 profile and eventual medical retirement of soldiers.

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The Prevalence and Severity of Chronic Pain in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358121993995 ◽

2021 ◽

Vol 8 ◽

pp. 205435812199399

Author(s):

Sara N. Davison ◽

Sarah Rathwell ◽

Sunita Ghosh ◽

Chelsy George ◽

Ted Pfister ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Chronic Pain ◽

Pain Management ◽

Meta Analysis ◽

Pain Severity ◽

Chronic Pain Management ◽

Dialysis Patients ◽

Severity Scores ◽

The Mean

Background: Chronic pain is a common and distressing symptom reported by patients with chronic kidney disease (CKD). Clinical practice and research in this area do not appear to be advancing sufficiently to address the issue of chronic pain management in patients with CKD. Objectives: To determine the prevalence and severity of chronic pain in patients with CKD. Design: Systematic review and meta-analysis. Setting: Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity. Patients: Adults with glomerular filtration rate (GFR) category 3 to 5 CKD including dialysis patients and those managed conservatively without dialysis. Measurements: Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of pain, and severity of pain. Methods: Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library, last searched on February 3, 2020. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of overall chronic pain, musculoskeletal pain, bone/joint pain, muscle pain/soreness, and neuropathic pain and the I2 statistic was computed to measure heterogeneity. Random effects models were used to account for variations in study design and sample populations and a double arcsine transformation was used in the model calculations to account for potential overweighting of studies reporting either very high or very low prevalence measurements. Pain severity scores were calibrated to a score out of 10, to compare across studies. Weighted mean severity scores and 95% confidence intervals were reported. Results: Sixty-eight studies representing 16 558 patients from 26 countries were included. The mean prevalence of chronic pain in hemodialysis patients was 60.5%, and the mean prevalence of moderate or severe pain was 43.6%. Although limited, pain prevalence data for peritoneal dialysis patients (35.9%), those managed conservatively without dialysis (59.8%), those following withdrawal of dialysis (39.2%), and patients with earlier GFR category of CKD (61.2%) suggest similarly high prevalence rates. Limitations: Studies lacked a consistent approach to defining the chronicity and nature of pain. There was also variability in the measures used to determine pain severity, limiting the ability to compare findings across populations. Furthermore, most studies reported mean severity scores for the entire cohort, rather than reporting the prevalence (numerator and denominator) for each of the pain severity categories (mild, moderate, and severe). Mean severity scores for a population do not allow for “responder analyses” nor allow for an understanding of clinically relevant pain. Conclusions: Chronic pain is common and often severe across diverse CKD populations providing a strong imperative to establish chronic pain management as a clinical and research priority. Future research needs to move toward a better understanding of the determinants of chronic pain and to evaluating the effectiveness of pain management strategies with particular attention to the patient outcomes such as overall symptom burden, physical function, and quality of life. The current variability in the outcome measures used to assess pain limits the ability to pool data or make comparisons among studies, which will hinder future evaluations of the efficacy and effectiveness of treatments. Recommendations for measuring and reporting pain in future CKD studies are provided. Trial registration: PROSPERO Registration number CRD42020166965

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Impact of galcanezumab on total pain burden: findings from phase 3 randomized, double-blind, placebo-controlled studies in patients with episodic or chronic migraine (EVOLVE-1, EVOLVE-2, and REGAIN trials)

The Journal of Headache and Pain ◽

10.1186/s10194-020-01190-7 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Jessica Ailani ◽

J. Scott Andrews ◽

Mallikarjuna Rettiganti ◽

Robert A. Nicholson

Keyword(s):

Chronic Migraine ◽

Migraine Headache ◽

Pain Severity ◽

Life Questionnaire ◽

Double Blind ◽

Double Blind Placebo ◽

Link Type ◽

Total Pain ◽

Maximum Pain ◽

The Impact

Abstract Background Focus on the frequency of migraine pain may undervalue the total burden of migraine as pain duration and severity may present unique, additive burden. A composite measure of total pain burden (TPB; frequency, severity, and duration) may provide a more comprehensive characterization of pain burden and treatment response in patients with episodic migraine (EM) or chronic migraine (CM). The impact of galcanezumab versus placebo on TPB among patients with EM or CM was analyzed. Methods Patients from randomized, double-blind, placebo-controlled episodic (two 6-month studies pooled) and chronic migraine (3-month) studies received once-monthly subcutaneous injection of galcanezumab 120 mg or placebo. A post hoc analysis of TPB for a given month was calculated as severity-weighted duration by multiplying duration (hours) and maximum pain severity (0 = none, 1 = mild, 2 = moderate, 3 = severe) of migraine for each day and summing these over the days in a month. Least square mean change from baseline in monthly TPB across Months 1–6 (EM, N = 444 galcanezumab, N = 894 placebo) and Months 1–3 (CM, N = 278 galcanezumab, N = 558 placebo) were compared using a mixed-model repeated measures model. Correlation of the Migraine Specific Quality of Life Questionnaire (MSQ) and Migraine Disability Assessment Scale (MIDAS) to TPB at baseline was assessed. Results At baseline, the duration of migraine on a given migraine headache day accounted for the greatest unique proportion of variability (EM, 57.4% and CM, 61.1%) to TPB after adjusting for frequency of migraine headache days and maximum pain severity. The decrease from baseline in monthly TPB was greater with galcanezumab than placebo for patients with EM (68.6 versus 36.2) and CM (102.6 versus 44.4). The average percent reduction of TPB from baseline was significantly greater with galcanezumab compared with placebo in patients with EM (50.8% versus 17.2%) and CM (29.7% versus 11.0%). In patients with EM and CM, TPB correlated with MSQ total score (r = − 0.35 and r = − 0.37) and MIDAS (r = 0.34 and r = 0.32). Conclusions Greater reduction in TPB was seen in patients with EM and CM treated with galcanezumab 120 mg once-monthly injection relative to placebo. Discussing TPB supports patient-centric conversations regarding treatment expectations when clinicians are evaluating options for migraine prevention. Trial registration ClinicalTrials.gov: #NCT02614183 (I5Q-MC-CGAG; EVOLVE-1), #NCT02614196 (I5Q-MC-CGAH; EVOLVE-2), and #NCT02614261 (I5Q-MC-CGAI; REGAIN) – all 3 trials were registered on 23 November 2015.

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CHRONIC PAIN CONTRIBUTES TO INJURIOUS FALLS IN COMMUNITY-DWELLING OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.2318 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S622-S622

Author(s):

Yurun Cai ◽

Suzanne Leveille ◽

Ling Shi ◽

Tongjian You ◽

Ping Chen

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Community Dwelling ◽

Pain Severity ◽

Pain Interference ◽

Fall Injuries ◽

Injurious Falls ◽

Multisite Pain ◽

Community Dwelling Older Adults ◽

Pain Distribution

Abstract Fall injuries are a leading cause of death among older adults, and chronic pain has been identified as a fall risk factor. However, the potential impact of chronic pain on injurious falls is unknown. This prospective study examined the relation between chronic pain and injurious falls in a 4-year follow-up of community-dwelling older adults. The MOBILIZE Boston study recruited 765 older adults aged ≥70y living in the Boston area. Pain characteristics, including pain severity, pain interference, and pain location, were measured at baseline using the Brief Pain Inventory subscales and a joint pain questionnaire. Musculoskeletal pain distribution was categorized as “no pain”, “single site pain”, or “multisite pain”. Injurious falls were ascertained in telephone interviews following reports of falls on the monthly fall calendar postcards. The overall rate of injurious falls was 35/100 person-years. Negative binomial models, adjusting for sociodemographics, BMI, chronic conditions, mobility difficulty, analgesic and psychiatric medications, and depression, showed that pain interference and pain distribution, but not pain severity, independently predicted injurious falls. Participants in the highest third of pain interference scores had a 53% greater risk of injurious falls compared to those in the lowest pain interference group (adj.IRR=1.53, 95% CI: 1.15, 2.05). Older adults with multisite pain had a 50% higher risk of injurious falls than those without pain (adj.IRR=1.50, 95% CI: 1.16, 1.93). Risk of injurious falls related to pain was stronger among women than men. Research is needed to determine effective strategies to prevent fall injuries among older adults with chronic pain.

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