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Revista Dor

Print version ISSN 1806-0013On-line version ISSN 2317-6393

Rev. dor vol.17 no.4 São Paulo Oct./Dec. 2016

https://doi.org/10.5935/1806-0013.20160089 

ORIGINAL ARTICLES

Prevalence of self-referred chronic pain and intercurrences in the health of the elderly

Ezequiel Vitório Lini1 

Camila Tomicki2 

Rodrigo Britto Giacomazzi1 

Marcos Paulo Dellani3 

Marlene Doring4 

Marilene Rodrigues Portella4 

1Universidade de Passo Fundo, Departamento de Fisioterapia, Passo Fundo, RS, Brasil.

2Universidade Federal de Santa Catarina, Departamento de Educação Física, Florianópolis, SC, Brasil.

3Instituto de Desenvolvimento do Alto Uruguai, Getúlio Vargas, RS, Brasil.

4Universidade de Passo Fundo, Programa em Envelhecimento Humano, Passo Fundo, RS, Brasil.


ABSTRACT

BACKGROUND AND OBJECTIVES:

Chronic pain is a public health problem eliciting personal and social losses. This study aimed at identifying the prevalence of chronic pain and its repercussions in the health of the elderly.

METHODS:

This was a transversal, population-based study with 416 elderly living in a city to the South of Brazil. Data were collected by home interviews with the Health, Wellbeing and Aging research questionnaire. Chronic pain was considered dependent variable and socio-demographic and health condition characteristics were considered independent variables. Descriptive and inferential data analysis was carried out. Pearson Chi-square and Fisher Exact tests were used for the association between categorical variables, with significance level of 5%. Logistic regression model was used for raw and adjusted analysis.

RESULTS:

Chronic pain prevalence was 54.7%, mostly in females (64.8%). Among the elderly with chronic pain, 58.6% have classified their health as regular, poor or very poor, 53.3% did not practice physical activities, 19.8% have mentioned difficulties to perform basic daily life activities and 82.5% have referred pain in lower limbs and 74.8% in lumbar region (p<0.001).

CONCLUSION:

Measures to decrease chronic pain in the elderly should be priority, especially in primary health attention services, because this is a multidimensional and complex public health problem.

Keywords: Aging; Health of the elderly; Health services; Pain; Primary health attention

RESUMO

JUSTIFICATIVA E OBJETIVOS:

A dor crônica é um problema de saúde pública que provoca prejuízos pessoais e sociais. O objetivo deste estudo foi identificar a prevalência de dor crônica e a repercussão na saúde dos idosos.

MÉTODOS:

Realizou-se um estudo transversal de base populacional com 416 idosos residentes em município no Sul do Brasil. Coletaram-se os dados por inquérito domiciliar com o questionário da pesquisa Saúde, Bem-Estar e Envelhecimento. Consideraram-se como variável dependente a dor crônica; e independente as características sócio-demográficas e as relacionadas às condições de saúde. Realizou-se análise descritiva e inferencial dos dados. Na associação entre as variáveis categóricas, utilizaram-se os testes Qui-quadrado de Pearson e Exato de Fisher, com nível significativo de 5%. Na análise bruta e ajustada, foi utilizado o modelo de regressão logística.

RESULTADOS:

A prevalência de dor crônica foi de 54,7%, em sua maioria mulheres (64,8%). Entre os idosos com dor crônica, 58,6% classificaram sua saúde como regular, ruim ou muito ruim, 53,3% não praticavam atividade física, 19,8% apontaram dificuldades para atividades básicas de vida diária e 82,5% referiram dor nos membros inferiores e 74,8% na região lombar (p<0,001).

CONCLUSÃO:

Medidas de redução da dor crônica no idoso devem ser priorizadas, em especial pelos serviços de atenção primária à saúde, por se tratar de um problema de saúde pública multidimensional e complexo.

Descritores: Atenção primária à saúde; Dor; Envelhecimento; Saúde do idoso; Serviços de saúde

INTRODUCTION

In Brazil, population is going through a fast aging process, due to significantly low fecundity rate, low mortality and improved general life conditions, which is expressed by longer mean life expectation and longevity1.

This phenomenon is often followed by high incidence of chronic and degenerative diseases. As a consequence, there are functional deficits, increased dependence and installation of painful processes2,3.

Pain is defined by the International Association for the Study of Pain (IASP), as an unpleasant sensory and emotional experience, manifested in the presence of real or potential tissue injuries. Pain is subjective and each individual determines its intensity based on previous experiences and on socio-cultural and/or environmental factors4. Duration determines typification, that is, acute pain is that lasting for no longer than days or weeks while chronic pain goes beyond three months5.

Considered a public health challenge, chronic pain affects important part of the elderly population, with perceived personal and financial losses which impair quality of life (QL)6,7. Pain is among major factors able to interfere with QL of the elderly because it limits their activities, increases agitation, risk for stress and social isolation8.

It is estimated that 7 to 40% of the world population suffer from chronic pain9,10. The Brazilian Society for the Study of Pain (2014) points that 30% of the population suffer with chronic pain. Brazilian studies with community-dwelling elderly, confirm the high prevalence of chronic pain, estimated in approximately 30%9,11-13. In light of the above, this study aimed at identifying the prevalence of chronic pain and its repercussions in the health of the elderly.

METHODS

This is a cross-sectional population-based study with elderly living in a small city to the South of Brazil. The Basic Attention Information System (SIAB) for the year 2011, of the city's Department of Health, was used to identify and locate studied population. For sample calculation, the acceptable error was 0.05 and confidence interval 95%. To the total, 5% were added to compensate possible losses (non eligibility, refusals, among others). Total sample was made up of 416 elderly. Initially they were listed by dwelling zones and gender, and then selected by random sampling keeping gender proportions for each sector. Inclusion criteria were living for at least six months in the territory of the city; having, during interview, cognitive conditions to answer to the questionnaire and/or presence of a relative or caregiver to help with the answers. Exclusion criteria were individuals not found after three attempts; moving to a different city; death during data collection; eligible individuals refusing to participate. Data were collected in the first semester of 2011, by means of home survey, using the Health, Well-Being and Aging Survey (SABE) questionnaire. In this study, sections A (personal and family information), D (health conditions and lifestyle) and section E (functional evaluation) were analyzed.

Dependent variable was that related to the presence or not of chronic pain (pain for more than three months, continuous, or episodes of this pain at least once a month), and independent variables were those related to socio-demographic characteristics and health conditions.

Statistical analysis

Data were submitted to descriptive and bivariate analysis. Chisquare and Fisher Exact tests were used to check the association between categorical variables, and logistic regression model was used for raw and adjusted analysis with effect measures expressed in odds ratio. Significance level was 5%. To be part of the multiple model, variables with p≤0.20 were considered.

The project was approved by the Research Ethics Committee, Universidade de Passo Fundo, opinion 017/2011, CAAE 0281.0.398.000.11.

RESULTS

Participated in the study 416 people aged ≥60 years. From these, most were females (56.7%), with mean age of 69±7.6 years. Chronic pain prevalence was 54.7%, mostly among females (64.8%) (p<0.001), and 66.5 of the elderly lived in the urban area. There has been no significant difference in chronic pain prevalence by dwelling zone, be it urban or rural.

Among respondents, most were married (66.5%); however marital status has not interfered with the distribution of chronic pain complaints, as well as the fact of living alone or with companion. Among elderly with income above three minimum wages, 29.8% had no chronic pain, while 17.7% have referred pain (p=0.042). From elderly who worked, 23.8% had no pain, 11.4% yes (p=0.001). Being or not literate made no significant difference in the distribution of self-referred chronic pain (Table 1).

Table 1 Distribution of the elderly with regard to socio-demographic variables and self-referred pain, Estação (RS), Brazil (n=416) 

Chronic pain p value
No Yes
n % n %
Gender
Male 100 52.9 80 35.2 <0.001
Female 89 47.1 147 64.8
Age group (years)
60 - 69 103 54.5 107 47.1 0.092
70 -79 70 37.0 86 37.9
80 or above 16 8.5 34 15.0
Dwelling zone
Urban 128 67.7 148 65.2 0.803
Rural 29 15.4 35 15.4
Mixed 32 16.9 44 19.4
Marital status
Married 141 75.0 164 72.2 0.098
Widow/er 33 17.6 56 24.7
Single 8 4.3 3 1.3
Separate 6 3.2 4 1.8
Living alone
No 164 86.8 189 83.3 0.320
Yes 25 13.2 38 16.7
Total monthly income
No income 10 5.3 20 8.8 0.034
Up to 1 minimum wage 57 30.2 85 37.4
1 to 2 minimum wages 65 34.4 82 36.1
3 to 5 minimum wages 51 27.0 36 15.9
+ than 5 minimum wages 6 3.2 4 1.8
Currently working
No 144 76.2 201 88.6 0.001
Yes 45 23.8 26 11.4
Literate
Yes 170 89.9 195 85.9 0.211
No 19 10.1 32 14.1

Among the elderly without chronic pain, 78.7% have self-evaluated their health as very good and good, among those with pain, 58.6%, have classified their health as regular, poor or very poor (p<0.001). When comparing current health with that of one year ago, 40.5% of the elderly considered their health worse (p<0.001). Not practicing physical activity was reported by 53.3% of the elderly with pain and by 31.4% of those without pain (p<0.001). Among chronic pain elderly, 19.8% have reported difficulties to perform basic daily life activities, while 3.7% without chronic pain have reported dependence. (p<0.001) (Table 2).

Table 2 Distribution of the elderly with regard to health and self-referred chronic pain variables, Estação (RS), Brazil (n=416) 

Variables Chronic pain p value
No Yes
n % n %
Health self-evaluation
Very good/good 149 78.8 94 41.4 <0.001
Regular/poor/very poor 40 21.2 133 58.6
Comparison with health 1 year ago
Equal 127 67.2 105 46.3 <0.001
Better 46 24.3 30 13.2
Worse 16 8.5 92 40.5
Physical activity
Yes 129 68.2 106 46.7 <0.001
No 60 31.8 121 53.3
BDLA
No difficulty 182 96.3 182 80.2 <0.001
With difficulty 7 3.7 45 19.8

BDLA = basic daily life activities.

Continuous pain for more than three months was referred by 54.7% of the elderly. As to pain location, 82.5% have referred in lower limbs; 74.8% in lumbar region; 55.8% in upper limbs; 32.3% in neck; 31.3% in head; 19% in abdomen and 11.9% in the chest. Chronic pain especially impairs ambulation (70.9%), sleep (13.7%), taking care of themselves (3.5%), in addition to interfering with mood, appetite and/or leisure (11.9%).

Adjusted analysis has shown significant associations between chronic pain and variables gender (OR=1.76), health self-perception (OR=4.16) and dependence for basic daily life activities (BDLA) (OR= 3.48) (Table 3).

Table 3 Raw and adjusted analysis of self-referred chronic pain by the elderly, Estação/RS – Brazil 

Variables OR*(CI95%) p value OR** (CI95%) p value
Gender
Male 1.00 1.00
Female 2.06 (1.38-3.08) 0.000 1.76 (1.14-2.69) 0.010
Health self-perception
Very good/good 1.00 1.00
Regular/poor 5.27 (3.28-8.46) 0.000 4.16 (2.64-6.56) 0.000
Health self-perception compared to 1 year ago
Better 1.00
Equal 1.26 (0.74-2.15) 0.378
Worse 8.81 (3.95-19.64) 0.000
Current work
Yes 1.00
No 2.41 (1.41-4.13) 0.001
BDLA
Independent 1.00 1.00
Dependent 6.43 (2.75-15.02) 0.000 3.48 (1.46-8.29) 0.005
Physical activity
Yes 1.00
No 2.45 (1.62-3.71) 0.000

*OR = Raw odds ratio estimated by univariate logistic regression;

**OR: adjusted odds ratio calculated by multivariate logistic regression; BDLA = basic daily life activities.

DISCUSSION

Our results have shown expressive proportion of elderly with self-referred pain for more than three months. Chronic pain is a concern for the elderly because it negatively impacts their safety, autonomy and independence, limiting their BDLA or social interaction, with direct impairment of QL14. A study carried out in São Paulo15 has found a lower proportion (29.7%) of painful elderly; however authors have considered chronic pain as pain lasting for at least six months.

Chronic pain was more frequent among females. There are evidences that pain is felt differently by males and females. Studies have shown that females have higher pain perception due to differences in control mechanisms, be them excitatory or inhibitory16,17. Genetic, psychological and cultural factors should be also taken into consideration5. Similarly, a review study16 showed that females have lower pain threshold as compared to males after nociceptive stimuli. These results are in line with Brazilian studies18,19 and are similar to an investigation carried out in Portugal20.

As to chronic pain site, our results have shown higher prevalence of lower limbs, followed by lumbar region and upper limbs. It seems reasonable to admit the presence of pain in these regions, since it is a common symptom of chronic diseases related to locomotor system, common condition in the elderly population. Similarly, other studies21 have indicated lower limbs and lumbar region as primary sites affected by pain in the elderly.

This study results also showed association between chronic pain and practice of physical activities. Preponderant factor for the difficulty of performing physical activities is exactly pain location, since it primarily affects lower and upper limbs, lumbar and cervical spine22. Chronic pain impairs movement, restricts movement amplitude and, as a consequence, becomes a barrier for the practice of physical activity15,22,23.

There has been reference to BDLA impairment when the elderly had chronic pain. These results are in disagreement with those mentioned in the study24, where authors have not found significant differences in BDLA performance, however using a different tool, the Older American Resources and Services, to evaluate dependence levels.

International studies have indicated that pain interferes with functional capacity of the elderly25-28. Our results confirm a different population-based study carried out in Brazil, which has pointed to pain in community-dwelling elderly as a determining factor for incapacity15.

Most painful elderly have classified their health as regular, poor or very poor. Pain is referred as one determinant for negative health self-evaluations among the elderly29,30. Chronic pain leads to worse health perception. There are evidences that people define their health as poor or very poor when there are comorbidities or grievance, which is also the case in the presence of pain31. Chronic pain also interferes with individuals' wellbeing and QL, be them elderly or not30,32.

CONCLUSION

It was observed that the prevalence of chronic pain among the elderly was high, especially among females. This complaint directly and negatively affects health self-evaluation and impairs functionality to perform BDLA.

Sponsoring sources: none.

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Received: July 17, 2016; Accepted: October 27, 2016

Correspondence to: Universidade de Passo Fundo - Divisão de TI, BR 285 - São José 99052-900 Passo Fundo, RS, Brasil. E-mail: ezequielfisio@yahoo.com.br

Conflict of interests: none

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