Chronic musculoskeletal pain among elderly in rural Tamil Nadu: Mixed-method study

Abstract

Objectives: (1) To determine the prevalence of chronic pain of musculoskeletal origin at different body sites among elderly (≥60 years). (2) To study the determinants of chronic pain and the healthcare seeking behavior among elderly with chronic pain. (3) To explore the perceptions of chronic pain among elderly. Materials and Methods: This study was done in 55 field practice villages of the Rural Health Training Centre (RHTC) of the Department of Community Medicine, SMVMCH, Puducherry. An Exploratory Mixed-Method study design, where a qualitative phase (in-depth interviews [IDI]) followed the quantitative phase (Survey). A representative sample of 850 respondents was selected by two-stage cluster sampling. A trained investigator did a house-to-house visit and interviewed selected elderly respondents by using predesigned and pretested questionnaire. The intensity of chronic pain was measured using the Functional Rating Scale and Numeric Rating Scale. The manual content analysis was done for qualitative data. Multiple logistic regression was performed on quantitative data. Results: Qualitative data were described under two broad themes: (1) perceptions of elderly people about chronic pain and 2) healthcare seeking and coping mechanisms. Prevalence of chronic pain among the elderly respondents was found to be 47.6%. Most common site for chronic pain was knee joint (64.5%) followed by a low backache (21.7%). Most of the older people with chronic pain had mild-to-moderate and tolerable pain. Two predictors for chronic pain were the age of the respondent (adjusted OR -1.03, 95% CI = 1.01–1.05) and the presence of at least one chronic morbidity (adjusted OR -1.37, 95% CI = 1.03–1.82). Conclusions and Recommendations: Since the chronic pain was found to be associated with aging and the presence of at least one of the chronic morbidities, it is crucial for treating community physicians to consider the comorbid conditions while managing chronic pain in elderly. Considering the complex nature of chronic pain in old age, the primary care physician should be trained in drug and context-specific nondrug interventions to address the biomedical causes and other cognitive-behavior factors, respectively, through active support from their family and neighborhood.

A cross-sectional survey of the perspectives of older people in the Scottish Highlands on the management of their chronic pain

“…Whilst acknowledging the challenges of assessing and managing chronic pain in older people, this study does indicate that evidence of the provision of appropriate integrated and person-centred care is lacking. This finding resonates with other studies in urban [21,22], and remote and rural areas [12,13] across the world. These also highlighted age as a key predictor for chronic pain and suboptimal management in older people who often report poor effectiveness.…”

“…There are acknowledged difficulties associated with the provision of, and access to, healthcare within remote and rural areas, particularly for older people [12,13]. NHS Highland is the largest geographical health board in Scotland with a population of around 310,000 (<10% of the Scottish population) and more than 40% living in 'remote rural' locations (settlements with a population <3,000 people and a drive time of >30 minutes to a settlement of ≥10,000) [14].…”

Prevalence and characteristics of chronic Pain in the Chinese community-dwelling elderly: a cross-sectional study

“…With the population aging, a rise in prevalence for chronic and degenerated diseases is inevitable, leading to a high incidence of chronic pain in the elderly [2,3]. Previous studies have investigated the incidence of chronic pain in the elderly, showing a prevalence ranging from 43.8 to 55.2% in elderly population residing in the east [4][5][6][7] while 40 to 66% prevalent among those in the west [8,9]. Moreover, the most common sites of pain in older people are the back, leg, knee or hip, and 'other' joints (such as joints of fingers, wrists and toes) in the most developed countries [10].…”

Prevalence of Musculoskeletal Disorders Amongst Adult Population of India

“…Most common site for chronic pain was knee joint (64.5%) followed by a low backache (21.7%). 6 A cross-sectional study conducted by Mendhe HG et al (2016) in Andhra Pradesh revealed that overall prevalence of MSD was 61%. Joint pain was the most common symptom in the study participants (47.7%), 16% had joint stiffness, 19.75% had muscle pain, 20.7% had spine or back pain, and 23.25% had joint swelling.…”