N. Cirino1, M.P. Aquino1, C. Lima1, F. Santos2, M. Ventura3, M. Perracini1
1Universidade Cidade de São Paulo - UNICID, São Paulo, Brazil, 2Universidade Federal de São Paulo, São Paulo, Brazil, 3Hospital do Servidor Público Estadual – HSPE, Geriatria, São Paulo, Brazil
Background: Chronic pain is highly prevalent among older adults population, ranging between 25.4-56.2%. Chronic pain and frailty syndrome result from multisystem disorders and share common pathophysiological mechanisms, such as neuroendocrine dysregulation and changes in the nervous system structure and function. The odds of developing frailty are two-fold when older persons experience any pain and three-fold when experiencing chronic pain compared to older adults without pain. Although chronic pain causes significant suffering and disability among older people, studies on chronic pain experience amongst frail older adults are still scarce.
Purpose: To compare chronic pain measures between non-frail, pre frail and frail older adults, and to identify if there is an association between these pain measures and frailty syndrome.
Methods: Cross-sectional exploratory study with older adults aged 60 and older with chronic pain. Pain was assessed using the Visual Analog Scale (VAS), Geriatric Pain Measure (GPM-p), Geriatric Psychosocial Assessment of Pain-induced Depression (GEAP) and Neuropathic Pain Questionnaire (DN4). The frailty syndrome was identified using the frailty phenotype. The groups were compared according to the following characteristics: chronic pain’s intensity and experience, neuropathic pain screening, depression due to chronic pain, number of pain sites using one-way ANOVA tests with Tukey and Kruskal - Wallis post hoc, according to the adherence to normal distribution. A multivariate logistic regression analysis was performed to identify the association of chronic pain measures and frailty (being non frail and pre frail vs being frail), adjusted for covariates. A sample size calculation was ascertained using the Geriatric Pain Measure (GPM), considering an α of 0.05 and 1-β of 0.90, to differentiate the groups resulting in 34 participants per group.
Results: Of the 135 participants included, 36.3% were non-frail, 38.5% were pre-frail and 25.2% were frail. Groups did not differ in terms of the mean pain intensity (p = 0.132), but when we rated VAS in categories, the frail older did present severe pain more frequently (p = 0.009). The frail older adults had a worse score for neuropathic pain (4.1; 95% CI 3.2 - 5.1) and for depression associated with chronic pain (9.7; 95% CI 7.9 - 11.5) when compared to the not frail older adults (p> 0.001). Regarding the multidimensional experience of pain, frail older participants had a worse score (59.4; 95% CI 51.7 - 67.2) when compared to not frail (p = 0.001) and pre frail older people (p = 0.017). In multivariate regression, there was an independent association between being frail and multidimensional painful experience [OR=1.03; 95% CI 1.01 - 1.06) and chronic pain-induced depression [OR=1.28; 95% CI 1.13 - 1.46), respectively.
Conclusion(s): Frail older adults have a poor chronic pain experience regarding the positive screening for neuropathic pain, depression induced by chronic pain and multidimensional impact of pain. There is an independent association between chronic pain and being frail.
Implications: Frail older adults have a poor chronic pain experience regarding the positive screening for neuropathic pain, depression induced by chronic pain and multidimensional impact of pain. There is an independent association between chronic pain and being frail.
Funding, acknowledgements: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
Keywords: chronic pain, frailty, assessment
Topic: Pain & pain management
Did this work require ethics approval? Yes
Institution: Universidade Cidade de São Paulo - UNICID
Committee: Comité de Ética em Humanos
Ethics number: 3158954
All authors, affiliations and abstracts have been published as submitted.
