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Pain and mortality

mechanisms for a relationship

Smith, Dianea,*; Wilkie, Rossa; Croft, Petera; Parmar, Simranb; McBeth, Johnc

doi: 10.1097/j.pain.0000000000001193
Research Paper
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Moderate to severe chronic pain affects 1 in 5 adults and its impact increases with age. People with chronic pain that interferes with their lives have an increased risk of mortality. Identifying how interfering chronic pain can lead to mortality may highlight potential intervention strategies. This study uses a novel approach to test whether lifestyle, health, social, and psychological factors mediate the relationship between pain and mortality. Survival analyses (Cox's proportional hazard modelling and a technique to assess mediation within survival models) were conducted on a large population study of adults aged 50 years or older from the English Longitudinal Study of Ageing (n = 6324). Data collected at wave 2 (2004) were used as baseline and follow-up was until 2012. The relationship between being “often troubled with pain” and mortality was examined. Lifestyle, health, social, and psychological factors were tested as potential mediators. The strongest mediating factors for the relationship between troubling pain and mortality were functional limitation (hazard ratio 1.31; 95% confidence interval 1.20-1.39), symptoms preventing walking quarter of a mile (1.45 [1.35–1.58]), physical inactivity (1.14 [1.10-1.20]), and poor self-rated health (1.32 [1.23-1.41]). Mediators of the relationship between troubling pain and mortality provide targets for preventive health programmes. Interventions to improve general health, activity, and function could improve long-term survival in patients with this clinical problem.

Musculoskeletal pain that impacts on an individual's life is linked to premature mortality. Key factors to target to reduce this risk are identified.

aArthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom

bKeele Medical School, Keele University, Staffordshire, United Kingdom

cFaculty of Medical and Human Sciences, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, United Kingdom

Corresponding author. Address: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, United Kingdom. E-mail address: diane.smith@mmu.ac.uk (D. Smith).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

A copy of this manuscript was published as a preprint at: http://eprints.keele.ac.uk/2415/1/SmithDPhD2016.pdf?

Received September 26, 2017

Received in revised form February 03, 2018

Accepted February 15, 2018

© 2018 International Association for the Study of Pain
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