Profiles of Chronic Pain and Cognitive Concerns: A Cluster Analysis Among Older Adults Enrolled in a Mind-body...

Chronic pain and cognitive concerns are highly comorbid, particularly among older adults, though the specific severity and symptom overlap may vary across individuals. We aimed to characterize distinct profiles of individuals with chronic pain and subjective cognitive concerns (concern of persistent cognitive decline, with or without objective cognitive deficits) and compare demographic/psychosocial variables between subgroups. We analyzed baseline data from an ongoing randomized controlled trial comparing a mind-body activity intervention to a health education control. As part of the larger study, older adults with chronic musculoskeletal pain and subjective cognitive concerns completed measures of pain severity (NRS), pain interference (PROMIS), and subjective (ECog-12) and objective cognitive dysfunction (RBANS). Participants also completed measures of mental health symptoms (anxiety, depression), general psychosocial factors (loneliness, mindfulness, self-compassion, coping skills), and pain-specific psychological factors (pain catastrophizing, kinesiophobia, pain self-efficacy). An exploratory hierarchical cluster analysis examined unique symptom profiles among participants with complete data (n=251) on the four pain/cognitive dysfunction variables, and multivariate logistic regression models examined cluster membership by demographic and psychosocial variables. We identified a three-cluster solution: (1) lowest symptom burden (n=101); (2) mixed symptom burden (n=93); and (3) highest symptom burden (n=57). Several demographic, mental health, and psychosocial factors significantly distinguished between subgroup membership. Results elucidate the heterogeneity in clinical presentations within these two overlapping conditions and suggest specific potential risk factors for experiencing greater symptom burden. Findings overall represent an important first step in identifying which older adults may benefit most from interventions for co-occurring chronic pain and cognitive concerns. PERSPECTIVE: This article characterizes distinct profiles of older adults with chronic pain and cognitive concerns and suggests potential risk factors for experiencing greater symptom burden. Findings can help inform which older adults are most likely to benefit from interventions targeting co-occurring chronic pain and cognitive concerns.