Widespread pain and progression of disability

Many older adults suffer from bodily pain. While some pain is due to arthritis, some arises from the soft tissues and structures surrounding joints. It is as important to appreciate the functional consequences of pain, as it is to understand the nature and cause of painful symptoms. We sought to determine whether widespread pain increases the risk of worsening disability in women age 65 and older with moderate to severe disability at the beginning of the study. (Ann Intern Med 135(12):1038, 2001)

The Womens Health and Aging Study is a prospective cohort study of 1002 women that presents a unique opportunity to address this question due to its focus on disability outcomes and its rigorous adjudication of medical conditions that extends beyond self-report. The findings of this study were as follows. First, approximately 24% of participants began the study with widespread pain, while 25% had no pain or mild pain at a single site. Second, women with widespread pain were 2.5-3.5 times more likely to have severe difficulty with daily activities, walking or lifting at the start of the study as women with localized or no pain. Of those women who did not begin the study with severe difficulty, women with widespread pain doubled the risk of progression to severe activity difficulty. The authors conclude that widespread pain is frequent among older disabled women and also predict progression to severe disability.

Editorial Comment: This study demonstrates that pain, specifically widespread pain, is relatively common in this cohort of disabled older women and also demonstrates that such symptoms are associated with worsening function over time. The studys prospective, longitudinal design, focus on a segment of the population at risk of severe disability, and use of ACR classification to define widespread pain, and controls for potential confounding factors comprise strengths of this study. These findings should be interpreted cautiously, however, since these data represent the association between painful symptoms and disability severity in this cohort – within which individuals might vary considerably. Furthermore, the difference between epidemiologic investigation such as this one and clinical practice is highlighted by the need to investigate the cause of painful symptoms with each patient. This was not done in this study.