Chronic multisite pain: evaluation of a new geriatric syndrome

Abstract

Background: Chronic musculoskeletal pain is highly prevalent in the older adults, and individuals with musculoskeletal pain frequently report pain in two or more sites.

Aims: To determine the prevalence and characteristics of multisite pain in relation to other geriatric syndromes and to evaluate whether multisite pain may represent a distinct geriatric syndrome.

Methods: The MOBILIZE Boston Study is a population-based cohort study of older adults that enrolled 749 participants aged 70 and older. Persistent pain in the back and major joint areas was assessed using a joint pain questionnaire. Assessment of other geriatric syndromes included urinary incontinence, fall history, ADL disability, and frailty. A number of risk factors for geriatric syndromes were assessed.

Results: The prevalence of multisite pain was 40% in this population of older adults. Many participants had more than one geriatric syndrome, indicating substantial overlap in the prevalence of these conditions. Nearly half (48%) of participants with urinary incontinence or falls, 61% with ADL disability, and 49% of those with frailty also had multisite pain. Shared risk factors for established geriatric conditions were similarly distributed among the elderly population who had multisite pain. Demographic and health characteristics associated with multisite pain and other geriatric syndromes, included gender (female), depression, number of comorbid conditions, and mobility limitations.

Conclusion: Although prior studies have explored risk factors for chronic multisite pain, these findings reveal that multisite pain, often unexplained, bears many similarities to established geriatric syndromes. Multisite pain warrants further consideration as a unique geriatric syndrome.

Keywords: Chronic pain; Epidemiology; Geriatric syndrome; Older adults.

Fig. 1

Pain prevalence among older adults according to the presence of other geriatric syndromes (N=749)

Fig. 2

Percent of older adults with multisite pain according to specific pain sites (N=749). Participants reporting more than one chronic pain site, determined by self-report of pain in the previous month, present for at least three months in the previous year

Fig. 3

Prevalence of articular diseases according to pain category, (N=749). Mutually exclusive groupings according to the following hierarchy (descending order): osteoarthritis and spinal disease or disc disease, osteoarthritis>1 site, rheumatoid arthritis, disc disease/spinal disease, osteoarthritis of knee, osteoarthritis of hand. Brackets indicate conditions affecting multiple musculoskeletal sites