Pain and mortality: mechanisms for a relationship
- 19 March 2018
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Pain
- Vol. 159 (6), 1112-1118
- https://doi.org/10.1097/j.pain.0000000000001193
Abstract
Moderate to severe chronic pain affects 1 in 5 adults and its impact increases with age. People with chronic pain that interferes with their lives have an increased risk of mortality. Identifying how interfering chronic pain can lead to mortality may highlight potential intervention strategies. This study uses a novel approach to test whether lifestyle, health, social, and psychological factors mediate the relationship between pain and mortality. Survival analyses (Cox's proportional hazard modelling and a technique to assess mediation within survival models) were conducted on a large population study of adults aged 50 years or older from the English Longitudinal Study of Ageing (n = 6324). Data collected at wave 2 (2004) were used as baseline and follow-up was until 2012. The relationship between being “often troubled with pain” and mortality was examined. Lifestyle, health, social, and psychological factors were tested as potential mediators. The strongest mediating factors for the relationship between troubling pain and mortality were functional limitation (hazard ratio 1.31; 95% confidence interval 1.20-1.39), symptoms preventing walking quarter of a mile (1.45 [1.35–1.58]), physical inactivity (1.14 [1.10-1.20]), and poor self-rated health (1.32 [1.23-1.41]). Mediators of the relationship between troubling pain and mortality provide targets for preventive health programmes. Interventions to improve general health, activity, and function could improve long-term survival in patients with this clinical problem.Keywords
This publication has 45 references indexed in Scilit:
- The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate careBMC Public Health, 2013
- Painful Medical Conditions and Alcohol Use: A Prospective Study among Older AdultsPain Medicine, 2011
- Chronic widespread pain predicts physical inactivity: Results from the prospective EPIFUND studyEuropean journal of pain, 2010
- Objectively measured physical capability levels and mortality: systematic review and meta-analysisBMJ, 2010
- Levels of anxiety and depression as predictors of mortality: the HUNT studyThe British Journal of Psychiatry, 2009
- Musculoskeletal pain is associated with a long-term increased risk of cancer and cardiovascular-related mortalityRheumatology, 2008
- Association of Depression and Anxiety Alone and in Combination With Chronic Musculoskeletal Pain in Primary Care PatientsPsychosomatic Medicine, 2008
- Socioeconomic status and health: The role of subjective social statusSocial Science & Medicine (1982), 2008
- The cost of dichotomising continuous variablesBMJ, 2006
- BiasJournal of Epidemiology and Community Health, 2004