Lacey, RJ, Strauss, VY, Rathod, T, Belcher, J, Croft, PR, Natvig, B, Wilkie, R and McBeth, J (2015) Clustering of pain and its associations with health in people aged 50 years and older: cross-sectional results from the North Staffordshire Osteoarthritis Project. BMJ Open, 5 (11). ISSN 2044-6055

[thumbnail of R Lacey - Clustering of pain and its associations with health in people aged 50 years and older.pdf]
R Lacey - Clustering of pain and its associations with health in people aged 50 years and older.pdf - Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview


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.

Item Type: Article
Uncontrolled Keywords: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via BMJ at Please refer to any applicable terms of use of the publisher.
Subjects: R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Depositing User: Symplectic
Date Deposited: 30 Nov 2015 10:10
Last Modified: 08 Jun 2018 08:30

Actions (login required)

View Item
View Item