Chronic musculoskeletal pain raises elderly people's risk of falling, independent of their underlying pathologies or the medications they may be taking for the pain, according to a study of more than 700 elders living independently.
The finding that pain is “an overlooked and potentially important risk factor for falls” suggests that “the common complaint of aches and pains of old age is related to a greater hazard than previously thought,” Suzanne G. Leveille, Ph.D., R.N., of the University of Massachusetts, Boston, and her associates wrote.
“Daily discomfort may accompany not only difficulties in performing daily activities but equally as important may be a risk for falls and possibly fall-related injuries in the older population,” the authors wrote.
Dr. Leveille and her colleagues used data from the MOBILIZE Boston study to identify new strategies for preventing falls. (The study's title stands for Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly.) The researchers assessed data on 749 men and women aged 70 and older who were living in a variety of urban and suburban settings.
The study participants were evaluated during home and clinic visits at the beginning of the study. The researchers noted the severity and location of musculoskeletal pain, as well as its interference with daily activities. Monthly for up to 18 months thereafter, the participants reported pain symptoms and all falls on postcards.
This study design enabled the researchers to track the risk of falls over time in relation to baseline chronic pain and pain reported periodically.
Overall, 40% of the study subjects reported chronic polyarticular pain, and another 24% reported chronic pain in just one joint area. A total of 1,029 falls occurred during follow-up, with 405 subjects (54%) falling at least once during the study.
Compared with participants who did not report chronic pain, those who did had a significantly higher rate of falls, regardless of whether their pain was measured by location, severity, or degree of interference with daily life, Dr. Leveille and colleagues said (JAMA 2009;302:2214-21).
Chronic pain was persistently associated with fall risk after the data were adjusted to account for coexisting chronic conditions, other risk factors for falling, baseline balance and mobility, the use of psychotherapeutic medications, and the use of analgesics.
There also was a strong, graded relationship between monthly pain-severity ratings and the risk for falling during the subsequent month. “For example, among persons who reported severe or very severe pain for any given month on their calendar postcard, there was a 77% increased likelihood for a fall in the subsequent month, compared with those who reported no pain,” the investigators said. “Persons reporting even very mild pain also had an elevated risk of falling in any given month,” they added.
There are three possible mechanisms underlying the link between pain and falling, according to the researchers. First, joint pathology may cause both pain and the instability that can lead to falling. However, Dr. Leveille and her colleagues deemed that explanation unlikely because the association in this study was independent of hand and knee osteoarthritis and of mobility.
Second, the neuromuscular effects of pain could cause muscle weakness, slowed responses to an impending fall, or gait alterations, all of which can lead to falling. Third, chronic pain may distract patients or otherwise interfere with the cognitive activity needed to prevent falling.
Other studies have shown that patients with chronic pain show decreased executive function and attention. Moreover, avoiding or interrupting a fall “typically requires a cognitively mediated physical maneuver,” they noted.
Dr. Leveille reported no financial conflict of interest. The MOBILIZE Boston study was supported in part by a grant from Pfizer Inc.