Pain-related disability among older male veterans receiving primary care

Background. Pain is common among older persons and is associated with substantial disability, but factors that increase the risk for pain-related disability remain poorly defined. We sought to identify factors associated with disability due to pain in a sample of older veterans receiving primary care. Methods. Participants (N = 494) in this cross-sectional study included male veterans aged 65 years and older who were enrolled in a Veterans Affairs primary care clinic and who reported pain within the prior 12 months. Candidate factors included demographic, psychological, medical, and pain (e.g., intensity, site, duration) characteristics and were ascertained during face-to-face interviews. We assessed participants' level of pain-related disability by asking them to rate on a 0 to 10 scale the extent to which pain interfered with their ability to do daily activities (0 = no interference at all and 10 = no longer doing daily activities due to pain). Patients with scores of 0, 1-6, and 7-10 (approximate upper quartile) were classified as having no, low/moderate, and high pain-related disability. Results. The distribution of pain-related disability was none = 149 (30%), low/moderate = 210 (43%), and high = 135 (27%). Factors associated with high (vs no) pain-related disability included the presence of depressive symptoms, defined as a score of 16 or greater on the Center for Epidemiologic Studies-Depression scale (adjusted odds ratio [AOR] = 3.12, 95% confidence interval [CI] 1.42-6.85), and pain intensity, defined as a one-unit increase on a 0-10 numeric rating scale (AOR = 1.84, 95% CI 1.61-2.12). Other factors associated with high pain-related disability included the presence of pain on most days of every month (AOR = 3.59, 95% CI = 1.82-7.08) and low back pain (AOR = 2.36, 95% CI = 1.13-4.94). Depressive symptoms, pain intensity, and the presence of pain on most days of every month were also significantly and independently associated with low/moderate (vs no) pain-related disability. Conclusions. Pain-related disability is common among older male veterans receiving primary care. As modifiable factors, depressive symptoms and pain intensity are associated with pain-related disability and represent appropriate targets for intervention efforts among older persons with pain.