The multidimensional experience of noncancer pain: does cognitive status matter?
OBJECTIVE
Determine if the multidimensional pain-related experience differs between cognitively intact and impaired older adults.


METHODS
Cross-sectional analysis of the Canadian Study of Health and Aging.


METHODS
Community-dwelling older adults.


METHODS
Pain reports were dichotomized from a 5-point scale into no/very mild vs moderate and greater. Cognition measured by the Modified Mini Mental State Exam (0-100) was dichotomized into cognitively intact (>77) and cognitively impaired (≤77). Five self-rated Instrumental Activities of Daily Living (IADL) were dichotomized into no impairment vs any impairment. The Mental Health Inventory consists of five self-rated questions about psychological state and well-being, with scores ranging from 0 to 30; scores >11 indicate depression. Self-rated health was dichotomized into very good/pretty good and not too good/poor/very poor. Additional covariates included demographics and co-morbidities.


RESULTS
Of the 5,549 (97.3%) eligible participants, 1,991 (35.9%) reported pain of moderate intensity or greater, and 1,028 (18.5%) were cognitively impaired. Among cognitively impaired participants, moderate or greater pain report was associated with functional impairment odds ratio (OR) = 1.74 (1.15, 2.62; P < 0.01), depressed mood OR = 1.69 (1.18, 2.44; P < 0.01), and lower self-rated health OR = 2.35 (1.69, 3.30; P < 0.01). Among cognitively intact participants, pain report was similarly associated with functional impairment OR = 1.40 (1.20,1.63); P < 0.01), depressed mood OR = 1.88 (1.59,2.23; P < 0.01), and lower self-rated health OR = 2.34 (1.94,2.82; P < 0.01).


CONCLUSIONS
Pain self-report in both cognitively intact and impaired community-dwelling persons is associated with a similar multidimensional experience. These findings confirm the need for comprehensive evaluation of pain and related outcomes in all older adults, with appropriate pharmacologic and nonpharmacologic management.
University of Chicago, Section of Geriatrics and Palliative Medicine, Chicago, IL 60637, USA. jshega@gmail.com
Joseph W
JW
Shega
Mary
M
Ersek
Keela
K
Herr
Judith A
JA
Paice
Kenneth
K
Rockwood
Debra K
DK
Weiner
William
W
Dale
D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003072:Cognition Disorders / Q000453:epidemiology* / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010146:Pain / Q000453:epidemiology* / Q000523:psychology*