September 16, 2009
“Patients may be better served if pain and disability are evaluated and treated jointly rather than treated as separate issues.” - Dr. Kenneth Covinsky, MD
Younger people with pain look similar in terms of their disability to people who are two to three decades older without pain, according to a study published Sep 16 in the Journal of the American Geriatric Society.(1)
The results of the study revealed that people with pain develop the functional limitations classically associated with aging at much earlier ages.
Functional limitations that impair the ability to live independently increase markedly with age, and to examine the effect researchers looked at the data from the 18,531participants, aged 50 and older, who took part in the 2004 Health and Retirement Study.
The four physical abilities considered were:
• Mobility, for example walking or jogging;
• Stair climbing;
• Upper extremity tasks, and;
• Activity of daily living (bathing, dressing, eating etc) with or without help.
24% of participants had significant pain (often troubled by pain that was moderate or severe most of the time), and across all four physical abilities looked at, participants with pain had much higher rates of functional limitations than subjects without pain.
In the mobility function as an example:
• Of subjects aged 50 to 59 without pain, 37% were able to jog 1 mile and 91% were able to walk several blocks without difficulty,
• Compared to only 9% and 50%, respectively, in those with pain.
The study was led by Professor Kenneth Covinsky, MD, MPH, of the Division of Geriatrics at the University of California, San Francisco.
“We found that the abilities of those aged 50 to 59 with pain were far more comparable to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile and 55% were able to walk several blocks, making pain sufferers appear 20 to 30 years older than non-pain sufferers,” surmised Covinsky.
“After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations.”
This is the first study of its kind to examine the relationship of pain across the age span, and to identify the large magnitude of the association between pain and age related disability.
Although the strength of the association between pain and mobility limitation decreased somewhat with increasing age, a strong association between pain and mobility limitations persisted through the 10th decade of life.
“Our study cannot determine whether pain causes disability or whether disability causes pain. We think it is likely that both are true and that pain and disability probably can act together in ways that make both problems worsen in a downward spiral,” said Dr. Covinsky.
“One implication of our study is that pain and disability may not be fully separate processes, but may often be part of the same underlying process. Patients may be better served if pain and disability are evaluated and treated jointly rather than treated as separate issues.”
The editor of the Journal of the American Geriatric Society, Dr. Thomas Yoshikawa, added “The drastic effect that pain can have on sufferer’s abilities to carry out everyday tasks in their lives highlights the importance of managing pain and treating it effectively.
“Last month, we published our annual guidelines on the pharmacological management of persistent pain in older persons,(2) and this study really brings home how essential it is for healthcare providers to be able to improve quality of life through awareness of the best treatments.”
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Citations:
1. “Pain, Functional Limitations, and Aging,” Journal of the American Geriatric Society, Sep 2009, Covinsky KE, Lindquist K, Dunlop DD, Yelin E; Volume 57 Issue 9, Pages 1556 – 1561.
2. “Pharmacological Management of Persistent Pain in Older Persons; American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons,” JAGS, Aug 2009; Volume 57:1331–1346.
Source: Journal of the American Geriatric Society news release, Sep 16, 2009
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