Chronic Pain in Older Adults—A Perspective from Brazil

Common sense states that rheumatic pain is frequent in older people, and this may be due to a high prevalence of osteoarthritis and osteoporosis in this age group.¹ Nevertheless, these diseases are not always responsible for the symptoms attributed to them. Aging people may have—beyond cartilage degeneration and loss of bone mass—trophic changes of tendons, ligaments, and sarcopenia that, in turn, cause articular misalignment, microfractures, muscle spasms, and weakness, resulting in pain and incapacity.² A study done in Gironde, France³ showed that nearly three-fourths of the population older than age 60 had some form of musculoskeletal pain, most commonly in the limbs. Leveille et al,⁴ studying the same problem, observed that there was a high prevalence of generalized pain in the elderly that was more common in women and in those with a body mass index (BMI) over 30 kg/m². Factors such as emotional distress, social difficulties, genetic background for degenerative diseases, and daily habits related to joint stress may cause variations of these findings in diverse populations.

We interviewed 207 individuals who were over 60 years old for musculoskeletal pain. This study was approved by our local Research Ethics Committee. All patients signed consent forms and were submitted to a structured questionnaire with closed questions about demographic data (age, gender, and marriage status), existence of chronic musculoskeletal pain (> 3 times/wk for the last 6 mo), pain localization (head, face, back, arms and legs, joints, chest, and generalized pain if present in > 3 places), pain intensity (light, moderate, severe, and very severe), smoking habits, and presence of comorbidities. Next, we applied the Health Assessment Questionnaire (HAQ), a questionnaire used to measure life quality in musculoskeletal diseases and also deals with the capacity to execute activities of daily living.⁵ It has a result spectrum from 0-3, where “0” represents full capacity to execute daily tasks and “3” represents impossibility to perform them. In the HAQ study, we excluded patients with neurological damage that could interfere with the results. After this, we measured the height and weight of participants for BMI calculation. Obtained data were grouped in contingency and frequency tables.

We used the Fisher’s exact and Chi-squared tests for nominal data and the Mann-Whitney U test for the numerical data with the help of GraphPad Prism, 4.0, software. The significance adopted was 5%. In the 207 study participants, 62.8% were females and 37.2% were males, with a mean age of 71.0 ± 8.0 years. One hundred twenty-four were nonsmokers, and 83 had been exposed to tobacco. Mean obtained BMI was 25.95 ± 4.42 kg/m². Chronic musculoskeletal pain was found in 86.9% of study participants; the pain was considered light in 17% of them, moderate in 36%, severe in 27%, and very severe in 7% (Figure). The main locations of pain are shown in the Table. In examining the association of chronic musculoskeletal pain with gender, we found that this symptom was present in 83.6% of males and in 87.7% of females (P = 0.63). If only generalized pain was considered, it was present in 17.7% of females and 7.7% of males (P = 0.04). We did not find an association of chronic musculoskeletal pain with tobacco exposure (P = 0.43) or with BMI (P = 0.7). The mean HAQ in the elderly persons with chronic pain was 0.97 ± 0.8, and in those without it was 0.65 ± 0.85 (P = 0.03). Concerning comorbidities, 63.3% of interviewed people had arterial hypertension, 48.3% had diabetes mellitus, and 7.7% had angina pectoris, among others.

As seen in the present study, a large percentage of older people had chronic musculoskeletal complaints, and this symptom was considered moderate-to-severe in most cases. Although not being able to know the cause of the symptoms, it is clear that they do contribute to loss of quality of life. We could not demonstrate any association with gender, BMI, and tobacco with pain; generalized pain was more common in women. A relevant finding was the high number of comorbidities that can deteriorate if the patient uses nonsteroidal anti-inflammatory drugs for pain treatment.⁶ T

he authors report no relevant financial relationships.

From the Rheumatology Unit, Hospital Universitário Evangélico De Curitiba, Paraná, Brazil.

References

1. Kavanaugh A. Rheumatic disease in the elderly: A perfect storm. Rheum Dis Clin North Am2007;33:xi-xiii.

2. Buckwalter JA, Woo SL, Goldberg VM, et al. Soft-tissue aging and musculoskeletal function. J Bone Joint Surg 1993;75:1533-1548.

3. Brochet B, Michel P, Barberger-Gateau P, Dartigues JF. Population based study of pain in elderly people: A descriptive survey. Age Ageing 1998;27:279-284.

4. Leveille SG, Linh S, Hochberg MC, et al. Widespread musculoskeletal pain and the progression of disability in older disabled women. Ann Intern Med 2001;135:1038-1046.

5. Krishnan E, Tugwell P, Fries JF. Percentile benchmarks in patients with rheumatoid arthritis: Health Assessment Questionnaire as a quality indicator (QI). Arthritis Res Ther 2004;6:R505-R513. Published Online: September 14, 2004.

6. Tutuncu Z, Kavanaugh A. Rheumatic disease in the elderly: Rheumatoid arthritis. Rheum Dis Clin North Am 2007;33:57-70.