title: Pain, functional limitations, and aging.
abstract: OBJECTIVE
  To examine the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  The 2004 Health and Retirement Study (HRS), a nationally representative study of community-living persons aged 50 and older.
  
  
  METHODS
  Eighteen thousand five hundred thirty-one participants in the 2004 HRS.
  
  
  METHODS
  Participants who reported that they were often troubled by pain that was moderate or severe most of the time were defined as having significant pain. For each of four functional domains, subjects were classified according to their degree of functional limitation: mobility (able to jog 1 mile, able to walk several blocks, able to walk one block, unable to walk one block), stair climbing (able to climb several flights, able to climb one flight, not able to climb a flight), upper extremity tasks (able to do 3, 2, 1, or 0), and activity of daily living (ADL) function (able to do without difficulty, had difficulty but able to do without help, need help).
  
  
  RESULTS
  Twenty-four percent of participants had significant pain. Across all four domains, participants with pain had much higher rates of functional limitations than subjects without pain. Participants with pain were similar in terms of their degree of functional limitation to participants 2 to 3 decades older. For example, for mobility, of subjects aged 50 to 59 without pain, 37% were able to jog 1 mile, 91% were able to walk several blocks, and 96% were able to walk one block without difficulty. In contrast, of subjects aged 50 to 59 with pain, 9% were able to jog 1 mile, 50% were able to walk several blocks, and 69% were able to walk one block without difficulty. Subjects aged 50 to 59 with pain were similar in terms of mobility limitations to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile, 55% were able to walk several blocks, and 72% were able to walk one block without difficulty. After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations (adjusted odds ratio (AOR)=2.85, 95% confidence interval (CI)=2.20-3.69, for mobility; AOR=2.84, 95% CI=2.48-3.26, for stair climbing; AOR=3.96, 95% CI=3.43-4.58, for upper extremity tasks; and AOR=4.33; 95% CI=3.71-5.06, for ADL function).
  
  
  CONCLUSIONS
  Subjects with pain develop the functional limitations classically associated with aging at much earlier ages.
authors.affiliation: Department of Medicine, University of California at San Francisco, 4150 Clement, San Francisco, CA 94121, USA. covinsky@medicine.ucsf.edu
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Covinsky
authors.forename: Karla
authors.initials: K
authors.lastname: Lindquist
authors.forename: Dorothy D
authors.initials: DD
authors.lastname: Dunlop
authors.forename: Edward
authors.initials: E
authors.lastname: Yelin
mesh_terms: D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010146:Pain / Q000145:classification / Q000523:psychology*; D010147:Pain Measurement; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors
references.citation: J Am Geriatr Soc. 2003 Apr;51(4):451-8
references.pmid: 12657063
references.citation: Pain Med. 2008 May-Jun;9(4):409-24
references.pmid: 18346056
references.citation: Pain Med. 2003 Dec;4(4):311-20
references.pmid: 14750907
references.citation: J Gerontol A Biol Sci Med Sci. 2005 Jun;60(6):793-7
references.pmid: 15983185
references.citation: J Gen Intern Med. 1997 Dec;12(12):757-62
references.pmid: 9436895
references.citation: Ann Intern Med. 1998 Jan 15;128(2):96-101
references.pmid: 9441588
references.citation: JAMA. 1995 May 3;273(17):1348-53
references.pmid: 7715059
references.citation: Am J Epidemiol. 1993 Apr 15;137(8):845-57
references.pmid: 8484376
references.citation: J Am Geriatr Soc. 1994 Oct;42(10):1035-44
references.pmid: 7930326
references.citation: JAMA. 2003 Nov 12;290(18):2435-42
references.pmid: 14612480
references.citation: J Am Geriatr Soc. 2003 Dec;51(12):1702-9
references.pmid: 14687347
references.citation: J Gerontol A Biol Sci Med Sci. 2002 Nov;57(11):M727-32
references.pmid: 12403801
references.citation: Am J Med. 2004 Oct 1;117(7):484-91
references.pmid: 15464705
references.citation: J Am Geriatr Soc. 1997 Jan;45(1):92-100
references.pmid: 8994496
references.citation: Disabil Rehabil. 2001 Oct 15;23(15):654-64
references.pmid: 11720115
references.citation: Annu Rev Public Health. 1996;17:25-46
references.pmid: 8724214
references.citation: J Am Geriatr Soc. 2002 Jun;50(6 Suppl):S205-24
references.pmid: 12067390
references.citation: N Engl J Med. 1993 Jul 8;329(2):110-6
references.pmid: 8510687
references.citation: Clin Geriatr Med. 2001 Aug;17(3):417-31, v
references.pmid: 11459713
references.citation: Am J Public Health. 1991 Apr;81(4):443-7
references.pmid: 2003621
references.citation: J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-56
references.pmid: 11253156
references.citation: Ann Intern Med. 2001 Dec 18;135(12):1038-46
references.pmid: 11747382
references.citation: Ann Intern Med. 2003 Sep 2;139(5 Pt 2):455-9
references.pmid: 12965976
references.citation: J Am Geriatr Soc. 1994 May;42(5):481-9
references.pmid: 8176141
references.citation: Am J Public Health. 1994 Aug;84(8):1274-80
references.pmid: 8059885