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Clustering of pain and its associations with health in people aged 50 years and older: cross-sectional results from the North Staffordshire Osteoarthritis Project

Lacey, R J; Strauss, V Y; Rathod, T; Belcher, J; Croft, P R; Natvig, B; Wilkie, R; McBeth, J

Clustering of pain and its associations with health in people aged 50 years and older: cross-sectional results from the North Staffordshire Osteoarthritis Project Thumbnail


Authors

R J Lacey

V Y Strauss

T Rathod

P R Croft

B Natvig

J McBeth



Abstract

Objective Most pain in patients aged =50 years affects multiple sites and yet the predominant mode of presentation is single-site syndromes. The aim of this study was to investigate if pain sites form clusters in this population and if any such clusters are associated with health factors other than pain.

Setting Six general practices in North Staffordshire, UK.

Design Cross-sectional, postal questionnaire, study.

Participants Community-dwelling adults aged =50 years registered at the general practices.

Main outcomes measures Number of pain sites was measured by asking participants to shade sites of pain lasting =1 day in the past 4 weeks on a blank body manikin. Health factors measured included anxiety and depression (Hospital and Anxiety Depression Scale), cognitive complaint (Sickness Impact Profile) and sleep. Pain site clustering was investigated using latent class analysis. Association of clusters with health factors, adjusted for age, sex, body mass index and morbidities, was analysed using multinomial regression models.

Results 13 986 participants (adjusted response 70.6%) completed a questionnaire, of whom 12 408 provided complete pain data. Four clusters of participants were identified: (1) low number of pain sites (36.6%), (2) medium number of sites with no back pain (31.5%), (3) medium number of sites with back pain (17.9%) and (4) high number of sites (14.1%). Compared to Cluster 1, other clusters were associated with poor health. The strongest associations (relative risk ratios, 95% CI) were with Cluster 4: depression (per unit change in score) 1.11 (1.08 to 1.14); cognitive complaint 2.60 (2.09 to 3.24); non-restorative sleep 4.60 (3.50 to 6.05).

Conclusions These results indicate that in a general population aged =50 years, pain forms four clusters shaped by two dimensions—number of pain sites (low, medium, high) and, within the medium cluster, the absence or presence of back pain. The usefulness of primary care treatment approaches based on this simple classification should be investigated.

Journal Article Type Article
Acceptance Date Aug 17, 2015
Online Publication Date Nov 9, 2015
Publication Date Nov 9, 2015
Publicly Available Date Mar 29, 2024
Journal BMJ Open
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 5
Issue 11
DOI https://doi.org/10.1136/bmjopen-2015-008389
Keywords This is the accepted author manuscript (AAM). The final published version (version of record) is available online via BMJ at http://dx.doi.org/10.1136/bmjopen-2015-008389Please refer to any applicable terms of use of the publisher.
Publisher URL http://dx.doi.org/10.1136/bmjopen-2015-008389

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