In terms of physical limitations, people in pain seem decades older than their actual ages

By Steve Tokar

People in pain have the same degree of functional limitation as people who are pain-free but two to three decades older, according to a study of more than 18,000 older Americans led by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.

“Someone in their fifties who suffers pain experiences limitations in physical mobility that are similar to someone in their seventies or eighties who is not in pain,” says lead author Kenneth E. Covinsky, MD, MPH, a staff physician at SFVAMC and a professor of medicine at UCSF.

Covinsky says that while it’s “not news” that pain is associated with disability, “this is the first time pain has been looked at specifically in terms of aging, and as it relates to its impact on disability.”

The study, which appears in the September, 2009 issue of the “Journal of the American Geriatrics Society,” is by far the largest study of pain and disability ever carried out in the United States, according to Covinsky. “The participants live in communities all across the country, so there’s good reason to believe that this study represents what’s happening in the United States today,” he says.

The study involved 18,531 adults aged 50 and older. Participants were asked if they were often troubled by pain, and if so, whether the pain was mild, moderate, or severe. Moderate and severe pain were classified as significant.

The participants were then asked about four broad areas of physical limitation: mobility (walking and jogging); stair climbing; upper-body tasks such as pushing heavy objects and lifting groceries; and activities of daily living such as bathing, dressing, and eating.

A total of 24 percent of all participants reported being often troubled by significant pain. On average, those participants were as functionally limited as people two to three decades older who did not have significant pain.

The association between pain and disability was strong across all ages and all areas of function, report the authors. For example, 33 percent of people aged 50 to 59 who were in pain reported being able to climb several flights of stairs without difficulty, compared with 39 percent of 80 to 89 year-olds who were not in pain.

Covinsky says that the study was not designed to find out whether pain was causing the disability, or vice-versa. “The association was so strong it probably goes in both directions,” he says. “But the real point is that, whatever the initial cause, we physicians need to start thinking about pain and disability holistically, as part of the same underlying problem. When we think about taking care of patients in pain, the question is not just how do you manage their pain, but how do you help them to function better?”

One lesson of the study, says Covinsky, is that “if someone is talking about pain, the likelihood is that they will have trouble with things like walking and basic activities of daily living. So we need to ask that patient, ‘tell me how the pain affects your functioning.’”

Co-authors of the study are Karla Lindquist, MS, of UCSF and SFVAMC, Dorothy D. Dunlop, PhD, of Northwestern University, Chicago, Ill., and Edward Yelin, PhD, of UCSF.

The study was supported by funds from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging, some of which were administered by the Northern California Institute for Research and Education.

NCIRE - The Veterans Health Research Institute is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.