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Original Contribution
November 25, 2009

Chronic Musculoskeletal Pain and the Occurrence of Falls in an Older Population

Author Affiliations

Author Affiliations: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (Drs Leveille, Jones, Shmerling, Kiel, and Lipsitz); College of Nursing and Health Sciences, University of Massachusetts-Boston (Dr Leveille); Harvard Medical School (Drs Leveille, Jones, Kiel, Hausdorff, Shmerling, Lipsitz and Bean; Institute for Aging Research, Hebrew SeniorLife (Drs Jones, Kiel, and Lipsitz and Mr Kiely); and Spaulding Rehabilitation Hospital (Dr Bean), Boston, Massachusetts; Department of Neurology, Tel-Aviv Sourasky Medical Center, and Department of Physical Therapy, Tel Aviv University (Dr Hausdorff), Tel Aviv, Israel; and Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland (Dr Guralnik).

JAMA. 2009;302(20):2214-2221. doi:10.1001/jama.2009.1738

Context Chronic pain is a major contributor to disability in older adults; however, the potential role of chronic pain as a risk factor for falls is poorly understood.

Objective To determine whether chronic musculoskeletal pain is associated with an increased occurrence of falls in a cohort of community-living older adults.

Design, Setting, and Participants The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study is a population-based longitudinal study of falls involving 749 adults aged 70 years and older. Participants were enrolled from September 2005 through January 2008.

Main Outcome Measure Participants recorded falls on monthly calendar postcards mailed to the study center during an 18-month period.

Results There were 1029 falls reported during the follow-up. A report of 2 or more locations of musculoskeletal pain at baseline was associated with greater occurrence of falls. The age-adjusted rates of falls per person-year were 1.18 (95% confidence interval [CI], 1.13-1.23) for the 300 participants with 2 or more sites of joint pain, 0.90 (95% CI, 0.87-0.92) for the 181 participants with single-site pain, and 0.78 (95% CI, 0.74-0.81) for the 267 participants with no joint pain. Similarly, more severe or disabling pain at baseline was associated with higher fall rates (P < .05). The association persisted after adjusting for multiple confounders and fall risk factors. The greatest risk for falls was observed in persons who had 2 or more pain sites (adjusted rate ratio [RR], 1.53; 95% CI, 1.17-1.99), and those in the highest tertiles of pain severity (adjusted RR, 1.53; 95% CI, 1.12-2.08) and pain interference with activities (adjusted RR, 1.53; 95%CI, 1.15-2.05), compared with their peers with no pain or those in the lowest tertiles of pain scores.

Conclusions Chronic pain measured according to number of locations, severity, or pain interference with daily activities was associated with greater risk of falls in older adults.