Eggermont Laura H P, Leveille Suzanne G, Shi Ling, Kiely Dan K, Shmerling Robert H, Jones Rich N, Guralnik Jack M, Bean Jonathan F
Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands.
J Am Geriatr Soc. 2014 Jun;62(6):1007-16. doi: 10.1111/jgs.12848. Epub 2014 May 13.
To determine the effects of chronic pain on the development of disability and decline in physical performance over time in older adults.
Longitudinal cohort study with 18 months of follow-up.
Urban and suburban communities.
Community-dwelling older adults aged 65 and older (N = 634).
Chronic pain assessment consisted of musculoskeletal pain locations and pain severity and pain interference according to the subscales of the Brief Pain Inventory. Disability was self-reported as any difficulty in mobility and basic and instrumental activities of daily living (ADLs, IADLs). Mobility performance was measured using the Short Physical Performance Battery (SPPB). Relationships between baseline pain and incident disability in 18 months were determined using risk ratios (RRs) from multivariable Poisson regression models.
Almost 65% of participants reported chronic musculoskeletal pain at baseline. New onset of mobility difficulty at 18 months was strongly associated with baseline pain distribution: 7% (no sites), 18% (1 site), 24% (multisite), and 39% (widespread pain, P-value for trend < .001). Similar graded effects were found for other disability measures. Elderly adults with multisite or widespread pain had at a risk of onset of mobility difficulty at least three times as great as that of their peers without pain after adjusting for disability risk factors (multisite pain: risk ratio (RR) = 2.95, 95% confidence interval (CI) 1.58-5.50; widespread pain: RR = 3.57, 95% CI = 1.71-7.48). Widespread pain contributed to decline in mobility performance (1-point decline in SPPB, RR = 1.47, 95% CI = 1.08-2.01). Similar associations were found for baseline pain interference predicting subsequent mobility decline and ADL and IADL disability. Weaker and less-consistent associations were observed with pain severity.
Older community-dwelling adults living with chronic pain in multiple musculoskeletal locations have a substantially greater risk for developing disability over time and for clinically meaningful decline in mobility performance than those without pain.
确定慢性疼痛对老年人残疾发展及身体机能随时间下降的影响。
为期18个月随访的纵向队列研究。
城市和郊区社区。
65岁及以上的社区居住老年人（N = 634）。
慢性疼痛评估包括根据简明疼痛问卷的子量表对肌肉骨骼疼痛部位、疼痛严重程度及疼痛干扰情况进行评估。残疾情况通过自我报告，涉及行动能力以及日常生活基本活动和工具性活动（ADL、IADL）方面的任何困难。行动能力表现采用简短体能测试电池（SPPB）进行测量。使用多变量泊松回归模型的风险比（RRs）来确定基线疼痛与18个月内新发残疾之间的关系。
近65%的参与者在基线时报告有慢性肌肉骨骼疼痛。18个月时行动困难的新发情况与基线疼痛分布密切相关：7%（无疼痛部位）、18%（1个部位）、24%（多个部位）和39%（广泛疼痛，趋势P值<0.001）。在其他残疾测量指标中也发现了类似的分级效应。在调整残疾风险因素后，患有多个部位或广泛疼痛的老年人出现行动困难的风险至少是无疼痛同龄人风险的三倍（多个部位疼痛：风险比（RR）=2.95，95%置信区间（CI）1.58 - 5.50；广泛疼痛：RR = 3.57，95% CI = 1.71 - 7.48）。广泛疼痛导致行动能力表现下降（SPPB下降1分，RR = 1.47，95% CI = 1.08 - 2.01）。在预测随后的行动能力下降以及ADL和IADL残疾方面，也发现了基线疼痛干扰的类似关联。在疼痛严重程度方面观察到的关联较弱且不太一致。
与无疼痛的老年人相比，患有多个肌肉骨骼部位慢性疼痛的社区居住老年人随着时间推移出现残疾以及行动能力表现出现具有临床意义下降的风险要大得多。
