Pain and health-related quality of life (HRQoL): a national observational study in community-dwelling older adults

The Influence of Physical, Mental, and Cognitive Factors on Health-Related Quality of Life among Community-Dwelling Older Adults: A Focus on Central Sensitization-Related Symptoms

Most older adults wish to maintain independence in their familiar communities. However, many experience pain and pain-related disabilities which reduce their health-related quality of life (HRQOL), leading to increased hospitalizations and mortality. This study aimed to determine the impact of physical, mental, and cognitive factors, particularly central sensitization-related symptoms (CSS), on the HRQOL of community-dwelling older adults. A total of 206 participants were included in the analysis, which measured HRQOL, basic attributes, physical functions and body pain, mental factors, cognitive factors, and CSS severity using validated tools. A correlation analysis was used to examine the association between HRQOL and each measure. Furthermore, multiple regression analysis (forced entry method) was performed to identify the factors influencing the HRQOL. The study found that pain intensity and CSS severity significantly influenced the HRQOL among community-dwelling older adults. The higher the pain intensity and CSS severity, the lower their HRQOL. The participants had mild pain and CSS, demonstrating the need to monitor, address, and treat even non-severe issues in community-dwelling older adults. This association, revealed for the first time in this study, suggests that approaches to reduce pain and CSS are important for maintaining and improving the HRQOL of community-dwelling older adults.

Morphological reflection of highly purified chondroitin sulfate action in patients with decompensated form of knee osteoarthritis

Objective: to study the morphological reflection of the parenteral form of highly purified chondroitin sulfate (CS) action in patients with osteoarthritis (OA) of the knee joints (KJ) during total knee arthroplasty (TA).

Patients and methods. An open, prospective, controlled, randomized study included 67 patients (24 men and 43 women aged 41—73 years) with stage III knee OA and grade 2 functional insufficiency. The 1st (control) group included 35 patients, the 2nd (main) group included 32 patients. At baseline of the study, all patients were taking non-steroidal anti-inflammatory drugs (NSAIDs) at a standard daily dose. Patients of the 2nd group 2 months before the TA of KJ, additionally received a parenteral form of CS (Honrogard®), intramuscularly every other day: the first 3 injections at a dose of 100 mg/day; and if tolerability was good starting from the 4th injection, at a dose of200 mg / day (course — 25 injections). The intensity of pain was assessed according to the visual analog scale, WOMAC index, functional status according to the KOOS (Knee and Osteoarthritis Outcome Score) scale and the Lequesne index, standard radiography and magnetic resonance imaging of the knee joint were performed with an assessment of the T2 relaxation time. TA KJ was carried out according to C. Ranawat method.

Results and discussion. In contrast to patients who took only NSAIDs, in patients who received CS during 50 days within 2 months before surgery, there were signs of adaptive restructuring in all layers of the preserved volume of hyaline cartilage and a decrease in the synovial membrane inflammation at the time of TA of KJ.

Conclusion. The obtained results allow us to recommend the use of the parenteral form of CS (Honrogard®) according to the described scheme within 2 months before the TA of KJ in order to improve the morphological characteristics of cartilage and synovial tissue in the joints of the contralateral lower limb, taking into account the increase in the load on it in the postoperative period.

Chronic pain: prevalent and independently associated with frailty and female gender in geriatric outpatients

PURPOSE

This study aims to determine the prevalence and factors independently associated with chronic pain.

METHODS

Participants  ≥ 65 years of age admitted to a geriatric outpatient-clinic were recruited between November 2012 and May 2018. Chronic pain is defined as presence of musculoskeletal system-based pain ongoing more than 3 months. Numeric rating scale (NRS) was applied to assess pain severity. Physical activity status was recorded as never or 1-2 times per week or everyday as appropriate. Following geriatric syndromes were assessed: sleep problem, fall within past year, depression by Geriatric Depression Scale Short Form (GDS-SF), frailty by FRAIL scale, functionality by modified Katz activities of daily living (ADL) and Lawton instrumental ADL scales, and quality of life by Euro-Quality of Life-5D (EQ-5D) and EQ Visual Analog Scale.

RESULTS

The study population consisted of 1441 patients. Of those, 969 were female and 472 were male. Mean age was 75.5 ± 6.6 years. The prevalence of chronic pain was 54.2% (n = 781). The median NRS score was 5 (1-10). Female gender, sleep problem, decreased functionality, and lower quality of life were independently associated with chronic pain after adjustment for educational status, presence of physical activity, fall within the past year, depression, and frailty. When the second analysis performed after the data with larger amount of missing value is removed, female gender and frailty remained independently associated with chronic pain.

CONCLUSION

Chronic pain is common and independently associated with female gender and frailty in geriatric outpatients. Factors those are associated with chronic pain, as documented in this study, may induce further longitudinal studies.

[Chronic pain in patients older than 60 years: a view of the geriatrics]

AIM

To analyze the geriatric status of patients with chronic pain.

MATERIAL AND METHODS

One hundred and sixteen patients of a geriatric unit, aged 75.66±7.98 years (110 women, 94.8%), were studied. All patients underwent general clinical examination and complex geriatric assessment, on the results of which geriatric syndromes were identified. Characteristics of pain syndrome (cause, intensity, localization) are described.

RESULTS

Chronic pain syndrome is identified in 85 (73.3%) patients. Most often pain is localized in large joints (n=44 (51.76%)) and back (n=50 (58.8%)). The intensity of pain was higher in patients with moderate dependence in daily activities compared to those with mild dependence (p<0.05). Pain intensity is associated with the degree of impairment of physical functioning (p<0.05). Patients with chronic pain have more geriatric symptoms (6.8±2.8). More syndromes (9.11±2.37) are identified in patients with marked impairment of physical functioning. The reduction of muscle strength is observed in 45.9% patients with- and 9.7% patients without chronic pain syndrome. The velocity of pace is 0.59 m/s and 0.71 m/s, respectively.

CONCLUSION

The high prevalence of chronic pain in patients of a geriatric unit is shown. The intensity of pain iss higher in patients with moderate dependence in daily activities compared to those with mild dependence. Pain intensity increases with the reduction of patient's physical functioning. Patients with chronic pain more often have dynapenia and significantly lower velocity of pace that indicates the poor outcome in elderly patients.