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Persistent pain and frailty: a case for homeostenosis
Joseph W Shega1, William Dale, Melissa Andrew
1Section of Geriatrics and Palliative Medicine (MC 6098), 5841 S. Maryland Ave., Chicago, IL 60637, USA. jshega@gmail.com
Objectives:
To compare the association between self-reported moderate to severe pain and frailty.
Design:
Cross-sectional analysis of the Canadian Study of Health and Aging Wave 2.
Setting:
Community.
Participants:
Representative sample of persons aged 65 and older in Canada.
Measurements:
Pain (exposure) was categorized as no or very mild pain versus moderate or greater pain. Frailty (outcome) was operationalized as the accumulation of 33 possible self-reported health attitudes, illnesses, and functional abilities, subsequently divided into tertiles (not frail, prefrail, and frail). Multivariable logistic regression assessed for the association between pain and frailty.
Results:
Of participants who reported moderate or greater pain (35.5%, 1,765/4,968), 16.2% were not frail, 34.1% were prefrail, and 49.8% were frail. For persons with moderate or greater pain, the odds of being prefrail rather than not frail were higher by a factor of 2.52 (95% confidence interval (CI) = 2.13-2.99; P < .001). For persons with moderate or greater pain, the odds of being frail rather than not frail were higher by a factor of 5.52 (95% CI = 4.49-6.64 P < .001).
Conclusion:
Moderate or higher pain was independently associated with frailty. Although causality cannot be ascertained in a cross-sectional analysis, interventions to improve pain management may help prevent or ameliorate frailty.
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