title: Older Age as a Prognostic Factor of Attenuated Pain Recovery After Shoulder Arthroscopy.
abstract: BACKGROUND
  Shoulder pain and surgery are common among older adults. However, the extent to which older age affects recovery after shoulder surgery is not well understood.
  
  
  OBJECTIVE
  To assess influence of older age on postoperative recovery factors 3 and 6 months after shoulder arthroscopy.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  University-affiliated outpatient orthopedic surgical center.
  
  
  METHODS
  A convenience sample of 139 persons between 20 and 79 years of age who experienced shoulder pain, had musculoskeletal dysfunction based on imaging and physician assessment, and were scheduled for an arthroscopic shoulder procedure.
  
  
  METHODS
  Postoperative outcomes were compared among younger, middle-aged, and older adults before surgery and at 3 and 6 months after surgery using analysis of variance modeling. Movement-evoked pain and an experimental laboratory correlate of pain processing were assessed at each time point. The influence of older age on 3- and 6-month pain outcomes were determined via multivariate regression analyses after accounting for preoperative, intraoperative, and postoperative prognostic factors.
  
  
  RESULTS
  Older adults had higher movement-evoked pain intensity (F2,108 = 5.18, P = .007) and experimental pain response (F2,111 = 7.24, P = .001) at 3 months compared with young and middle-aged adults. After controlling for key prognostic factors, older age remained a positive predictor of 3-month movement-evoked pain (R(2) = 0.05; standardized [St.] β = 0.263, P = .031) and experimental pain response (R(2) = 0.07; St. β = 0.295, P = .014). Further, older age remained a positive predictor of movement-evoked pain at 6 months (R(2) = 0.04; St. β = 0.231, P = .004), despite no age group differences in outcome. Older age was found to be the strongest predictor of 3- and 6-month movement-evoked pain.
  
  
  CONCLUSIONS
  Older adults may experience more pain related to movement, as well as endogenous pain excitation, in the first few months after shoulder arthroscopy. Future age-related research should consider use of movement-evoked pain intensity and experimental pain response as pain outcomes, as well as the utility of such measures in clinical care.
authors.affiliation: Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, 2004 Mowry Rd, PO Box 100242, Gainesville, FL 32610; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL(∗). Electronic address: coreysimon@phhp.ufl.edu.
authors.forename: Corey B
authors.initials: CB
authors.lastname: Simon
authors.affiliation: Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL(†).
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Riley
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, Nashville, TN(‡).
authors.forename: Rogelio A
authors.initials: RA
authors.lastname: Coronado
authors.affiliation: Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN(¶).
authors.forename: Carolina
authors.initials: C
authors.lastname: Valencia
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL(§).
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wright
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL(∗∗).
authors.forename: Michael W
authors.initials: MW
authors.lastname: Moser
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL(††).
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Farmer
authors.affiliation: Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, 2004 Mowry Rd, PO Box 100242, Gainesville, FL 32610; Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL(‡‡).
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D011379:Prognosis; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D020069:Shoulder Pain / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D016896:Treatment Outcome; D055815:Young Adult