Persistence of pain quality in community-dwelling older adults with chronic non-cancer pain.
Manu Thakral, Ling Shi, Janice B Foust and 4 others
PMID 29477646WHAT IT FOUND
Older adults with chronic pain kept the same pain-quality descriptors over 18 months, especially sensory pain.
Those reporting all three persistent categories had more widespread pain, but pain severity and interference did not change consistently.
Key findings
01Pain-quality descriptors were persistent over 18 months: 93.0% of people who reported sensory descriptors at baseline reported sensory descriptors again, 86.5% for cognitive/affective descriptors, and 80.6% for neuropathic descriptors.
02Older adults who kept all three pain-quality categories at both assessments were more likely to report more widespread pain at 18 months than those who kept one category (adjusted odds ratio 2.51) or two categories (adjusted odds ratio 2.20).
03Changes in pain severity and pain interference from baseline to 18 months were not statistically significant when persistent pain-quality categories were compared with non-persistent counterparts.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
Only 398 of 680 completed participants met the chronic pain and pain-quality criteria, so the results apply to that subgroup. The sample had to be able to walk across a small room without personal assistance, so it may not apply to frailer older adults. The analysis used only baseline and 18-month assessments, so it cannot capture how pain quality changes between or beyond those two points. The study did not account for progression of diagnosed pain conditions or treatments participants may have used to slow progression. Persistent versus non-persistent groups were small for some categories, so direct comparisons are limited. Pain interference was a global score and did not separate activities of daily living from instrumental activities of daily living. Results may not generalise to older adults with significant cognitive impairment because the pain-quality instrument was not validated in that group. Cultural variation in pain perception and communication may affect reported pain qualities. Twelve participants who endorsed completely different categories at both time points were excluded from adjusted models. Missing data were low for most descriptors, except gnawing, which had 10% missing.
Declared interests
The supplied text does not include a conflicts-of-interest or funding declaration. The article is tagged as supported by NIH extramural funding.
The easy way to misread this
Do not conclude that tracking pain quality will predict or improve pain severity or function. The study was observational, and changes in pain severity and interference were not statistically significant when persistent and non-persistent pain-quality categories were compared.