Physical activity and social and cultural engagement as risk-reducing factors in the prevention of chronic pain in older age: findings from a longitudinal cohort study

Abstract

BackgroundChronic pain is a major public health challenge as people age, and it is linked with impaired physical capacity, falls, fatigue, and depression. Despite growing research on chronic pain management, there is little research into chronic pain prevention. Research suggests that combinations of physical and psychosocial factors could be protective against the development of chronic pain in older age. But there is still a clear need to identify specific multimodal activities that could be encouraged as part of a broader healthy lifestyle. MethodsUsing data from the English Longitudinal Study of Ageing, we tracked adults aged 50 years or older who were free from chronic pain at baseline across a decade (wave 2 [2004–05] to wave 7 [2014–15]) and explored whether physical activity (weekly moderate or vigorous activity) or psychosocial engagement (monthly visits to the theatre, concerts, or museums or participation in community groups) reduced the risk of developing chronic pain. To confirm that pre-existing health conditions did not affect activity levels and predispose individuals to develop chronic pain, we further excluded individuals with a chronic health condition at baseline (eg, arthritis, cancer, chronic obstructive pulmonary disease, diabetes, stroke, angina). We used logistic regression analyses adjusted for identified socioeconomic, health, and social confounders and weighted for differential non-response. FindingsData from 2062 individuals were analysed (50·8% female, mean age 62·4 years [SD 7·6]). Over the 10 years, 748 participants (36·3%) experienced moderate-to-severe chronic pain, and for 337 (16·3%) this pain lasted for more than 2 years. Engaging in vigorous weekly activity was protective against the development of chronic pain (odds ratio 0·76, 95% CI 0·62–0·93) when controlling for all identified confounders. No effects were found for moderate weekly activity. Monthly cultural engagement was also protective against the development of chronic pain (0·77, 0·62–0·95), but community group participation was not. Sensitivity analyses found no evidence of reverse causality. InterpretationThis study supports previous work suggesting that vigorous (but not moderate) physical activity can be protective against the development of chronic pain in older age, and shows for the first time, to our knowledge, that cultural engagement could be a protective psychosocial activity. These results have implications for clinicians working with high-risk groups. FundingWellcome Trust (grant 205407/Z/16/Z) (for DF).