title: Chronic widespread pain is associated with worsening frailty in European men.
abstract: BACKGROUND
  we hypothesised that chronic widespread pain (CWP), by acting as a potential stressor, may predispose to the development of, or worsening, frailty.
  
  
  METHODS
  longitudinal analysis within the European Male Ageing Study (EMAS).
  
  
  METHODS
  a total of 2,736 community-dwelling men aged 40-79.
  
  
  METHODS
  subjects completed a pain questionnaire and shaded a manikin, with the presence of CWP defined using the American College of Rheumatology criteria. Physical activity, smoking, alcohol consumption and depression were measured. Repeat assessments took place a median of 4.3 years later. A frailty index (FI) was used, with frail defined as an FI >0.35. The association between CWP at baseline and the new occurrence of frailty was examined using logistic regression; the association between CWP at baseline and change in FI was examined using negative binomial regression.
  
  
  RESULTS
  at baseline, 218 (8.3%) men reported CWP. Of the 2,631 men who were defined as non-frail at baseline, 112 (4.3%) were frail at follow-up; their mean FI was 0.12 (SD 0.1) at baseline and 0.15 (SD 0.1) at follow-up, with a mean change of 0.03 (SD 0.08) P ≤ 0.001. Among men who were non-frail at baseline, those with CWP were significantly more likely to develop frailty. After adjustment for age and centre, compared with those with no pain, those with CWP at baseline had a 70% higher FI at follow-up; these associations remained significant after further adjustment for smoking, body mass index, depression, physical activity and FI at baseline.
  
  
  CONCLUSIONS
  the presence of CWP is associated with an increased risk of frailty in older European men.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust-Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Katie Fredrika
authors.initials: KF
authors.lastname: Wade
authors.affiliation: Cathie Marsh Institute for Social Research, The University of Manchester, Manchester, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Lee
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: John
authors.initials: J
authors.lastname: McBeth
authors.affiliation: Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: Rathi
authors.initials: R
authors.lastname: Ravindrarajah
authors.affiliation: Geriatric Medicine Department, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Evelien
authors.initials: E
authors.lastname: Gielen
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Pye
authors.affiliation: Laboratory of Clinical and Experimental Endocrinology, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Vanderschueren
authors.affiliation: Institute of Brain, Behaviour and Mental Health, The University of Manchester, Salford, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Pendleton
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Finn
authors.affiliation: Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Bartfai
authors.affiliation: Department of Medicine, Santiago de Compostela University, Santiago de Compostela, Spain.
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Casanueva
authors.affiliation: Department of Experimental Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Forti
authors.affiliation: University of Lund-Malmö University Hospital, Lund, Sweden.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Giwercman
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: Ilpo T
authors.initials: IT
authors.lastname: Huhtaniemi
authors.affiliation: Department of Andrology and Reproductive Endocrinology, Medical University of Łódź, Łódź, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kula
authors.affiliation: Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia.
authors.forename: Margus
authors.initials: M
authors.lastname: Punab
authors.affiliation: Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK Andrology Research Unit, Developmental and Regenerative Biomedicine Research Group, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.
authors.forename: Frederick C W
authors.initials: FC
authors.lastname: Wu
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust-Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Terence W
authors.initials: TW
authors.lastname: O'Neill
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging; D059350:Chronic Pain / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D018450:Disease Progression; D005060:Europe / Q000453:epidemiology; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: EMAS; ageing; frailty; male health; pain