JAMA Claims Chronic Musculoskeletal Pain Increases Fall Risk in Older Adults
SOURCE: Journal of the American Medical Association 2009; 302 (20): 2214-2221
Chronic pain is experienced by as many as two out of three older adults. Now, a new study finds that pain may be more hazardous than previously thought, contributing to an increased risk of falls in adults over age 70. The findings appear in the November 25 issue of The Journal of the American Medical Association (JAMA).
“It’s clear that pain is not just a normal part of aging and that pain is often undertreated in older adults,” explains lead author Suzanne Leveille, PhD, RN, who conducted the research while a member of the Division of Primary Care at Beth Israel Deaconess Medical Center (BIDMC) and is currently on the faculty at the University of Massachusetts Boston. “Our findings showed that older adults who reported chronic musculoskeletal pain in two or more locations – mainly in the joints of the arms and legs – as well as individuals who reported more severe pain or pain that interfered with daily activities were more likely to experience a fall than other individuals.”
Leveille used data gathered as part of MOBILIZE Boston (Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly), a cohort study headquartered at the Institute for Aging Research at Hebrew SeniorLife and led by Principal Investigator Lewis Lipsitz, MD. One of the goals of the study is to gain a better understanding of what causes falls in older adults in order to develop new ways to prevent falls from occurring.
Between September 2005 and January 2008, 749 adults over the age of 70 enrolled in the MOBILIZE study were interviewed about their health, including being asked questions about pain. They also underwent a physical assessment by a nurse. Over the next 18 months, the participants recorded any falls they had on monthly calendar postcards that were then mailed to the Institute for Aging Research.
“At the beginning of the study, 40 percent of the participants reported experiencing chronic pain in more than one joint area and 24 percent reported chronic pain in a single joint,” explains Leveille. “During the 18-month study period, the 749 participants reported a total of 1,029 falls, with more than half the participants falling at least once during this period.” Data analysis revealed that compared with study participants who reported no pain, the participants who experienced chronic pain in two or more joints had a 50 percent greater risk of falling.
“Our results suggest that pain should be added to the list of risk factors for falls, as persons who have chronic pain in two or more joints, and those who have moderate to severe pain or disabling pain, are at significantly higher risk,” says Leveille. “Assessment and management of chronic pain is a key part of health care for many older adults.”
This study was funded by a grant from the National Institute on Aging and support from Pfizer, Inc.
Study coauthors include Robert Shmerling, MD, of BIDMC; Hebrew SeniorLife Institute for Aging Research investigators Richard Jones, ScD, Dan Kiely, MPH, Douglas Kiel, MD, and Lewis Lipsitz, MD; Jonathan Bean, MD, of Spaulding Rehabilitation Hospital; Jeffrey Hausdorff, PhD, of Tel-Aviv Sourasky Medial Center; and Jack Guralnik, MD, PhD, of the National Institute on Aging.
Source: Journal of the American Medical Association
Thanks to Chiropractic Economics for access to this article!
Interesting. I guess we should get more studies on this but this is great info.
Good Info. Thanks
I thing its great that info and thanks again for making it available.
What we need next is a follow up study to monitor the hazards of taking an endless stream of NSAIDs to combat this chronic pain epidemic.
The Iatrogenic Injury Page contains sevaral serious articles detailing the NSAID-related gastrointestinal (GI) complications.
The most terrifying of them (American Journal of Medicine 1998 (Jul 27); 105 (1B): 31S–38S) prospectively followed patient status and outcomes, drug side effects, and the economic impact of illness for ~11,000 arthritis patients at 8 participating institutions in the United States and Canada.
By comparing the percentage of injury in this group, and then titrating those percentages to all those suffering (only) from rheumatoid arthritis, the authors stated:
Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.
It’s important to note that this is reportage from a serious medical journal. Numerous other articles have already detailed the risk of liver toxicity in children.
I think that part of the reason for these results is that, at least in my clinical experience, high musculoskeletal pain levels in older people is often correlated with low physical activity and fitness levels.
It may be that the pain causes less activity, or that decreased physical activity causes general lack of fitness and hence increased pain.
Dr. Fiske
It’s the classic “chicken and the egg” scenario. My take on it is that joints get fixated from activities and accidents. If those joints don’t “self-adjust”, or get corrected by one of us, then the joint will degenerate. Joints that don’t move thru full ROM will choke in their own waste products because it’s the normal pumping motion of an active joint that pumps out the waste and by diffusion (down the concentration gradient) draws in it’s nutrients. Loss of motion (and function) is the cause of degeneration (arthritis).
Classic pain-avoidance behavior dictates that people will stop moving painful joints, and worse yet, they take NSAIDS, which have also been shown to further injure cartilage.
Finally you have deconditioned individuals, who are now producing less endorphins, and are more prone to recurrent inflammation from trivial activities. Chronic recurrent. And these folks have more issues with maintaining balance and they also have slower reaction times to perturbations in their environment, which makes them more prone to falls.
“Old Habits Die Hard”, which makes it especially difficult to convince older patients about the perils of immunizations and over the counter and prescribed drugs and that they shouldn’t necessarily follow the advice of their medical doctor. After 35 years, I have FINALLY convinced my 86 year-old mother-in-law NOT to get an annual flu shot. She works out at the gym 5 days week, chooses organic food and is adjusted at least twice a week, but for whatever reason, immunizations were a sticking point. Until now. She FINALLY gets it! It has been a long process, but sometimes that is how progress it made, one patient at a time.
Of course chronic MS pain leads to more falls. If you’ve got MS pain you’ve got bad mechanics. Bad mechanics leads to less input into cerebellum and other structures involved in balance, and thus more falls.