Bryant Lucinda L, Grigsby Jim, Swenson Carolyn, Scarbro Sharon, Baxter Judith
Department of Preventive Medicine and Biometrics, University of Colorado at Denver and HSC, 4200 East Ninth Ave., Box C245, Office Annex 2C17, Denver, CO 80262, USA.
J Gerontol A Biol Sci Med Sci. 2007 Sep;62(9):989-96. doi: 10.1093/gerona/62.9.989.
Pain often accompanies chronic disease in older adults and may exacerbate physical limitations, which the Disablement Model suggests may increase disability and decrease independence. This study tests the hypothesis that chronic pain and change in levels of pain over time have associations with worsening physical performance independent of disease conditions.
We studied the effects of initial and changing levels of pain on observed physical performance over approximately 22 months in 925 community-dwelling Hispanic and non-Hispanic white participants in the San Luis Valley Health and Aging Study. Logistic regression models controlled for demographic variables, baseline performance, and comorbidities.
We found that chronic pain has an independent association with worsening physical performance, regardless of ethnicity. The intensity of the pain appears to have no independent effect. Although the presence of multiple comorbidities (or vascular disease or diabetes singly) also increases the risk of a worsened physical performance outcome, an independent effect of chronic pain remains after adjusting for these disease conditions. Furthermore, ongoing chronic pain increases the risk of worsening performance; obversely, recovery from chronic pain has a significant and substantial protective effect.
Pain in and of itself appears to increase physical impairment. These results strongly suggest that controlling chronic pain may interrupt the negative disease-impairment-disability trajectory by significantly reducing impaired physical performance, no matter the disease conditions that may underlie the pain.
疼痛常伴随老年人的慢性疾病，且可能加剧身体功能受限，失能模型表明这可能会增加残疾风险并降低独立性。本研究检验以下假设：慢性疼痛及疼痛水平随时间的变化与身体机能恶化相关，且独立于疾病状况。
在圣路易斯谷健康与衰老研究中，我们对925名居住在社区的西班牙裔和非西班牙裔白人参与者进行了约22个月的研究，观察初始疼痛水平及疼痛变化对身体机能的影响。逻辑回归模型对人口统计学变量、基线表现和合并症进行了控制。
我们发现，无论种族如何，慢性疼痛都与身体机能恶化存在独立关联。疼痛强度似乎没有独立影响。尽管存在多种合并症（或单独的血管疾病或糖尿病）也会增加身体机能恶化的风险，但在对这些疾病状况进行调整后，慢性疼痛的独立影响依然存在。此外，持续的慢性疼痛会增加机能恶化的风险；相反，从慢性疼痛中恢复具有显著且实质性的保护作用。
疼痛本身似乎会增加身体损伤。这些结果强烈表明，控制慢性疼痛可能会通过显著降低身体机能损伤来中断疾病 - 损伤 - 残疾的负面轨迹，无论疼痛可能潜在的疾病状况如何。
