Intensity outweighs duration in predicting pain disability
medwireNews: The intensity of musculoskeletal pain in older patients is an important predictor of disability across a range of day-to-day activities, researchers report.
Their cross-sectional study showed that global pain intensity in patients aged 50 years or older was strongly associated with the ability to get around, self-care, and carry out household activities and work. It was more important than other related factors such as age, depression, and number of comorbid chronic conditions.
“This indicates that global pain intensity is a better indicator of the level of disability than pain duration or number of pain sites,” lead study researcher Anabela Silva (University of Aveiro, Portugal) and colleagues comment in the Disability and Health Journal.
Noting that most patients seeking treatment for musculoskeletal pain present with pain at multiple sites, the team suggests that “global pain intensity should be included in routine clinical assessment of these patients and pain-related disability should be assessed for several domains of daily life.”
The 204 study participants had moderate-to-severe pain, scoring an average of 5.91 out of a possible 10 on a graphic rating scale, and the majority had chronic multisite or widespread pain that was always present. More than half of the patients reported pain in two or more sites, with the lumbar region and the lower limbs the most common sites.
The average total World Health Organization Disability Assessment Schedule (WHODAS 2.0) was 28.06, indicating moderate disability.
Global pain intensity and intensity at the most painful site correlated most closely with disability, and global pain intensity emerged as the most important factor for predicting total disability scores – explaining 19% of variance in scores – and disability in all domains except for cognition and getting along with others.
Disability in these two domains was most closely associated with chronic pain and the number of pain sites, while pain duration was significantly associated with disability in carrying out household activities.
Depression was also found to be an important predictor and when combined with global pain intensity explained 23% of the variance in total WHODAS 2.0 scores.
The researchers conclude that given the impact of global pain intensity on daily living activities, “treatment interventions aiming at decreasing global pain intensity rather than pain at a specific location may be more successful in decreasing pain associated disability than site-specific treatments.”
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Lucy Piper, Senior medwireNews Reporter