An article in the Journal of the American Medical Association, published late last year, describes what appears to be an increased risk for falls in elderly individuals who suffer severe and chronic pain throughout the body.
While it is unclear exactly how chronic pain causes an increase in the risk of falls, it is very clear that falls are among the top ten causes of death in older citizens in the United States. These falls are responsible for almost $20 billion dollars annually in health care costs. The record of the efforts to prevent falls has been fairly dismal in reducing the incidence of falls, and the cost of taking care of those who have suffered falls continues to rise.
The researchers set out to determine whether chronic musculoskeletal pain is associated with more falls among almost 750 adults over age 70 over an 18 month period between 2005 and 2008. During this period of observation over 1,000 falls were reported, and over half of the study participants fell at least once. There was a higher incidence of falls in study subjects reporting at least two locations of musculoskeletal pain compared to those reporting single-site pain, and even less in those who reported no musculoskeletal pain. More severe pain resulted in a higher number of falls; this was found even after adjusting for other fall risk factors and confounding issues.
Chronic pain, as measured by the number of pain foci and severity, in and of itself resulted in more falls. The researchers speculate that perhaps this pain serves as a distraction, causing the elderly to, for example, miss a step, or trip on an object. The pain interferes with the most basic cognitive activity necessary to ambulate without incident, not allowing for the cognitively mediated behavior required to avoid a fall.
Pain in and of itself is translated into a hazard to the successful achievement of the activities of daily living. This raises all sorts of questions and specters regarding how everyone and everything treats the complaints of chronic pain, at least in the older population. It will remain for further study to determine whether the control of pain reduces the risk of falls. But in the meantime, perhaps we should be treating those pain complaints more aggressively, and not just shrug our shoulders and mumble something about "it" being just old age. Also, insurance companies might need to study this matter more closely: While pain itself might not be considered a disability, does the existence of that pain lead to more disability, and should the insurers-whether disability or health-begin responding in a constructive way to the complaints of pain by their subscribers.
Perhaps chronic pain is a future cause of physical disability (for many, it already is a psychological blow), albeit the disabling event it causes might not have yet occurred. Some might say it is for the fortune tellers among us to determine when action should be taken in such cases. The paper discussed above would seem to be a call to start taking action now.
