Characteristics of chronic pain associated with sleep difficulty in older adults: the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston study

Abstract

Objectives: To evaluate pain severity and distribution in relation to sleep difficulty in older adults.

Design: Population-based cross-sectional study.

Setting: Community within a 5-mile radius of the study center at the Institute for Aging Research, Hebrew SeniorLife (HSL), Boston.

Participants: Seven hundred sixty-five participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study aged 64 and older.

Measurements: Pain severity was measured using the Brief Pain Inventory (BPI) Pain Severity Subscale. Musculoskeletal pain distribution was grouped according to no pain, single site, two or more sites, and widespread pain (upper and lower extremities and back pain). Three aspects of sleep difficulty were measured using items from the Center for Epidemiologic Studies Depression Scale, Revised (trouble getting to sleep, sleep more than usual, and restless sleep).

Results: Prevalence of trouble getting to sleep according to BPI severity was 17.8%, 19.7%, 32.0%, and 37.0% for the lowest to highest pain severity quartiles, respectively. Similar relationships between pain and sleep were observed across sleep measures according to pain severity and distribution. Adjusted for sociodemographic characteristics, chronic conditions, and health behaviors, chronic pain was strongly associated with trouble sleeping (≥ 1 d/wk) (single-site pain, odds ratio (OR)=1.77, 95% confidence interval (CI)=1.10-2.87; multisite pain, OR=2.38, 95% CI=1.48-3.83; widespread pain, OR=2.55, 95% CI=1.43-4.54, each compared with no pain). Similar associations were observed for restless sleep and sleeping more than usual. For specific pain sites alone or in combination with other sites of pain, only modest associations were observed with sleep problems.

Conclusion: Widespread or other multisite pain and moderate to severe pain are strongly associated with sleep difficulty in older adults. Further research is needed to better understand the burden and consequences of pain-related sleep problems in older adults.

Figure 1

Figure 1A. Pain severity was grouped into quartiles, indicated by Q1 to Q4, from least pain to most severe pain. The trend was statistically significant for associations between pain severity and each sleep problem using Mantel-Haenszel χ²₁ test, p <0.0001. The error bars indicate the standard error of the proportion. Figure 1B. Pain distribution was grouped as follows: no pain, pain in 1 site, pain in 2 or more sites, and widespread pain (WP). The trend was statistically significant for the association between pain measures and each sleep problem using Mantel-Haenszel χ²₁ test, p <0.0001. The error bars indicate the standard error of the proportion.

Figure 1

Figure 1A. Pain severity was grouped into quartiles, indicated by Q1 to Q4, from least pain to most severe pain. The trend was statistically significant for associations between pain severity and each sleep problem using Mantel-Haenszel χ²₁ test, p <0.0001. The error bars indicate the standard error of the proportion. Figure 1B. Pain distribution was grouped as follows: no pain, pain in 1 site, pain in 2 or more sites, and widespread pain (WP). The trend was statistically significant for the association between pain measures and each sleep problem using Mantel-Haenszel χ²₁ test, p <0.0001. The error bars indicate the standard error of the proportion.