Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Psychosocial and Community Health Department, School of Nursing, University of Washington, Seattle, Washington.
J Gerontol A Biol Sci Med Sci. 2019 Apr 23;74(5):733-741. doi: 10.1093/gerona/gly133.
This study aims to test whether persistent pain quality is associated with incident or worsening disability in four domains: mobility, activity of daily living (ADL) and instrumental activity of daily living (IADL) difficulty, and physical performance.
From the MOBILIZE Boston Study, a population-based cohort of adults aged ≥70 years, we studied participants with chronic pain who endorsed at least one pain quality descriptor (N = 398) and completed baseline and 18-month assessments. Pain quality was assessed using an adapted short-form McGill Pain Questionnaire with 20 pain quality descriptors in three categories: sensory, cognitive/affective, neuropathic. Persistence was defined as endorsing the same category at baseline and 18 months. Self-reported outcomes included mobility, ADL, and IADL difficulty. Physical performance was assessed using the short physical performance battery.
After adjusting for baseline pain severity and other covariates, individuals with three persistent categories had a greater risk of developing new or worsening IADL difficulty relative to those with one persistent category (relative risk [RR] 2.69, 95% confidence interval [CI] 1.34, 7.79). Similar results were observed for ADL difficulty (RR 5.83, 95% CI 1.32, 25.85), but no differences were noted in risk for mobility difficulty. There was no significant linear trend in physical performance over 18 months according to number of persistent categories (p =.68).
Elders with persistent pain quality experienced a higher risk of developing new or worsening IADL and ADL disability with each additional category but not mobility difficulty or poorer physical performance. Longitudinal assessment of pain quality could be useful in determining risk for global disability among elders with chronic pain.
本研究旨在测试持续性疼痛质量是否与四个领域的新发或恶化残疾相关：移动能力、日常生活活动（ADL）和工具性日常生活活动（IADL）困难以及身体表现。
本研究来自波士顿 Mobilize 研究，这是一项基于人群的 70 岁及以上成年人队列研究，我们研究了有慢性疼痛且至少有一个疼痛质量描述符的参与者（N=398），并完成了基线和 18 个月的评估。使用改良的 McGill 疼痛问卷短表和三个类别中的 20 个疼痛质量描述符评估疼痛质量：感觉、认知/情感、神经病理性。持续性定义为在基线和 18 个月时都有相同的类别。自我报告的结果包括移动能力、ADL 和 IADL 困难。身体表现通过简短的身体表现测试进行评估。
在调整基线疼痛严重程度和其他协变量后，与仅有一个持续性类别相比，有三个持续性类别的个体发生新的或恶化的 IADL 困难的风险更高（相对风险 [RR] 2.69，95%置信区间 [CI] 1.34，7.79）。ADL 困难也观察到类似的结果（RR 5.83，95% CI 1.32，25.85），但移动困难的风险无显著差异。根据持续性类别数量，18 个月期间的身体表现没有显著的线性趋势（p=.68）。
持续性疼痛质量的老年人每增加一个类别，新发或恶化 IADL 和 ADL 残疾的风险就会增加，但移动困难或身体表现较差的风险没有增加。对疼痛质量的纵向评估可能有助于确定慢性疼痛老年人的整体残疾风险。
