The relationship between chronic pain and obesity in the elderly
For the majority of older adults, chronic pain is a regular part of life
Chronic pain affects the elderly population more than any other demographic, and most community-dwelling adults are forced to deal with its burden, as large samples show up to 61% of older adults reporting chronic pain in the U.S. Though the exact relationship of chronic pain and age is uncertain, the negative impact of pain on functional performance and health-related quality of life (HRQoL) clearly increases with age. One important connection is that pain prevalence and severity have been linked to obesity in cases of osteoarthritis (OA), chronic headache and neuropathic pain, and higher body mass index (BMI) is known to hinder functional status and HRQoL. The mechanisms that cause this connection are not fully understood, but inflammation is considered a part of the causal pathway, and depression may be responsible since both obesity and chronic pain are associated with it. To develop a better understanding of this relationship, a sample was taken from the Einstein Aging Study (EAS) and a number of factors were investigated to see how they fit into the pain-obesity connection.
Sizable sample of elders undergo standard evaluation
All participants in the EAS were ambulatory, community-dwelling adults over 70. A total of 407 elders were selected as the study group and completed annual clinic assessments that included neurologic and cognitive testing. Medical history and other pertinent data were collected with structured interviews, and blood pressure, BMI and metabolic syndrome were measured at each visit. The Total Pain Index (TPI), which scores pain frequency and severity in eight locations on a 0-10 scale, was used to assess pain. Chronic pain was defined as pain in at least one area some of the time with at least moderate severity over the past three months.
Abdominal obesity strongly associated with chronic pain
Results showed that pain of any severity during the prior three months was reported by 308 (76%) participants, and 213 (52.3%) met the definition of chronic pain. Chronic pain was significantly associated with depression score, and depression scores increased rapidly as TPI scores went up. Both BMI and abdominal obesity were associated with chronic pain and higher TPI scores, and individuals with abdominal obesity were twice as likely to report chronic pain. In addition, 34% of the sample had metabolic syndrome, 70% had osteoarthritis, while only 24% had neuropathy. These findings contribute to the growing body of evidence that pain among community dwelling elders is associated with obesity, particularly abdominal obesity, which was the only individual component of metabolic syndrome linked to chronic pain and higher pain scores. An exercise intervention carefully catered to elders may therefore be beneficial in helping older adults reduce abdominal obesity while maintaining healthy bone mineral density and lean mass. Such a program could help reduce pain, thus improving mobility and HRQoL for elders.
-Summarized by Greg Gargiulo
-As reported in the Jan. '11 edition of Pain
