Identifying the activities affected by chronic nonmalignant pain in older veterans receiving primary care

OBJECTIVES: To identify the specific types of activities affected by chronic pain in older persons and the extent to which older individuals modify, perform less frequently, or terminate activities because of pain. DESIGN: Cross-sectional survey. SETTING: Primary care practice at a Veterans Affairs Medical Center in New England. PARTICIPANTS: Two hundred forty-four patients (aged 65-90) with chronic nonmalignant pain. MEASUREMENTS: Open-ended questions were used to identify the activities affected by pain; participants' responses were subsequently organized into distinct categories (e.g., climbing stairs under higher-order physical activities and going out to dinner under social/recreational activities). Participants were also asked to indicate whether they had modified, performed less frequently, or terminated these activities because of pain. RESULTS: Participants had a mean age +/- standard deviation of 75.4 +/- 5.2, were mostly male (84%), and had an average pain intensity score of 6.2 +/- 1.9 on a 0- to 10-scale. Two hundred three participants (83%) reported that pain affected one or more higher-order physical activities, and the corresponding percentages for the categories of social/recreational activities, instrumental activities of daily living, and basic activities of daily living were 74%, 57%, and 3%, respectively. The proportions of participants who modified, performed less frequently, or terminated one or more activities because of pain were 71%, 69%, and 22%, respectively. CONCLUSION: Assessing the effects of chronic pain across multiple functional domains is indicated in older primary care patients, particularly higher-order physical and social/recreational activities. Inquiring about whether the activities are modified, reduced, or terminated may also help to expand understanding of pain-related disability in older persons.