The Multidimensional Experience of Noncancer Pain: Does Cognitive Status Matter?

Objective. Determine if the multidimensional pain-related experience differs between cognitively intact and impaired older adults. Design. Cross-sectional analysis of the Canadian Study of Health and Aging. Setting. Community-dwelling older adults. Outcome Measures. Pain reports were dichotomized from a 5-point scale into no/very mild vs moderate and greater. Cognition measured by the Modified Mini Mental State Exam (0-100) was dichotomized into cognitively intact (>77) and cognitively impaired (<= 77). Five self-rated Instrumental Activities of Daily Living (IADL) were dichotomized into no impairment vs any impairment. The Mental Health Inventory consists of five self-rated questions about psychological state and well-being, with scores ranging from 0 to 30; scores >11 indicate depression. Self-rated health was dichotomized into very good/pretty good and not too good/poor/very poor. Additional covariates included demographics and co-morbidities. Results. Of the 5,549 (97.3%) eligible participants, 1,991 (35.9%) reported pain of moderate intensity or greater, and 1,028 (18.5%) were cognitively impaired. Among cognitively impaired participants, moderate or greater pain report was associated with functional impairment odds ratio (OR) = 1.74 (1.15, 2.62; P<0.01), depressed mood OR = 1.69 (1.18, 2.44; P<0.01), and lower self-rated health OR = 2.35 (1.69, 3.30; P<0.01). Among cognitively intact participants, pain report was similarly associated with functional impairment OR = 1.40 (1.20,1.63); P<0.01), depressed mood OR = 1.88 (1.59,2.23; P<0.01), and lower self-rated health OR = 2.34 (1.94,2.82; P<0.01). Conclusions. Pain self-report in both cognitively intact and impaired community-dwelling persons is associated with a similar multidimensional experience. These findings confirm the need for comprehensive evaluation of pain and related outcomes in all older adults, with appropriate pharmacologic and nonpharmacologic management.