Chronic widespread pain is associated with worsening frailty in European men.

Katie Fredrika Wade,Krzysztof Kula,Joseph D Finn,Terence W O'Neill,Evelien Gielen,Neil Pendleton,Frederick C W Wu,Dirk Vanderschueren,Margus Punab,Rathi Ravindrarajah,Ilpo T Huhtaniemi,Stephen R Pye,David M Lee,György Bartfai,John Mcbeth,Gianni Forti,Felipe F Casanueva,Aleksander Giwercman

doi:10.1093/ageing/afv170

Abstract

Background: we hypothesised that chronic widespread pain (CWP), by acting as a potential stressor, may predispose to the development of, or worsening, frailty.Setting: longitudinal analysis within the European Male Ageing Study (EMAS).Participants: a total of 2,736 community-dwelling men aged 40–79.Methods: subjects completed a pain questionnaire and shaded a manikin, with the presence of CWP defined using the American College of Rheumatology criteria. Physical activity, smoking, alcohol consumption and depression were measured. Repeat assessments took place a median of 4.3 years later. A frailty index (FI) was used, with frail defined as an FI >0.35. The association between CWP at baseline and the new occurrence of frailty was examined using logistic regression; the association between CWP at baseline and change in FI was examined using negative binomial regression.Results: at baseline, 218 (8.3%) men reported CWP. Of the 2,631 men who were defined as non-frail at baseline, 112 (4.3%) were frail at follow-up; their mean FI was 0.12 (SD 0.1) at baseline and 0.15 (SD 0.1) at follow-up, with a mean change of 0.03 (SD 0.08) P ≤ 0.001. Among men who were non-frail at baseline, those with CWP were significantly more likely to develop frailty. After adjustment for age and centre, compared with those with no pain, those with CWP at baseline had a 70% higher FI at follow-up; these associations remained significant after further adjustment for smoking, body mass index, depression, physical activity and FI at baseline.Conclusion: the presence of CWP is associated with an increased risk of frailty in older European men.

Highlights

Frailty is a common geriatric syndrome that becomes more prevalent with increasing age
Model 1: unadjusted, n = 2,525; Model 2: adjusted for age and centre, n = 2,525; Model 3: adjusted for age, centre, Body mass index (BMI), smoking status, depression and physical activity at baseline, n = 2,479. *P ≤ 0.05. **P ≤ 0.001
chronic widespread pain (CWP) was associated with the development of, and worsening, frailty as assessed using an frailty index (FI)

Summary

Introduction

Frailty is a common geriatric syndrome that becomes more prevalent with increasing age. There is no generally accepted definition of frailty; it has been defined as a ‘state of increased vulnerability to poor resolution of homeostasis after a stressor event, resulting from cumulative loss of physiological reserve’ [2]. Those suffering from frailty have been found to have an increased risk of hospitalisation and falls [3]. Perturbations in the Hypothalamic–Pituitary–Adrenal axis have been linked with the development of chronic pain [14], and we hypothesised that CWP, by acting as a stressor, would be associated with an increased risk of incident frailty. 200 men and 200 women aged 65–74 were recruited at each site

Methods

Results

Conclusion