Date of Award

12-31-2015

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Suzanne G. Leveille

Second Advisor

Ling Shi

Third Advisor

Janice B. Foust

Abstract

Chronic pain is a highly prevalent condition affecting at least half of older adults living in the community. Although pain quality is often collected in the health history for elders with chronic pain, its clinical value and relevance to disability is poorly understood. The purpose of this study was to determine the association of pain quality descriptors and their persistence to other pain characteristics, pain-associated chronic conditions, and 3 domains of disability: difficulty in mobility, ADLs and IADLs in community living older adults, aged 70 years and older. Pain quality was assessed using a modified version of the McGill Pain Questionnaire (MPQ) consisting of 20 pain quality descriptors. Other dimensions of pain assessed included severity, interference and location. A combination of factor analysis, the original MPQ categories, clinical theory and prior research was used to derive three categories of pain quality descriptors: (1) cognitive/affective, (2) sensory, and (3) neuropathic. The persistence of pain quality was defined as reporting descriptors within the same category(s) at baseline and 18 month follow up.

More than half of participants (65%) with chronic pain endorsed descriptors in all 3 categories at baseline (n=560 participants with chronic pain, out of n=722 total participants included at baseline. No clear etiology or diagnosis could be linked to any pain quality perhaps because of this high prevalence of variability in pain quality descriptors endorsed by older adults. Only modest differences were observed between categories in the prevalence of severe pain and interference, widespread pain, and severe disability in all 3 domains at baseline. The characteristics and correlates among those with persistent pain quality were similar across categories. After adjusting for sociodemographics, health characteristics and chronic conditions, older adults with persistent pain quality in any category had a two-fold or higher risk of developing new or worsening disability in all 3 domains compared to those without pain. Those with the most variability in their descriptions (all three categories) had the highest prevalence of disability in all three domains at baseline, and if persistent over 18 months, were at increased risk for developing disability compared to those with less variation in their descriptions of pain. These findings are applicable to current clinical practice for pain assessment and future investigations to determine risk factor profiles for disability in older adults.

Comments

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