Subjective Pain

LASA 115

Contact: Natasja van Schoor

Background
Pain is difficult to define scientifically. The International Association for the Study of Pain (IASP) offered the following definition in 1979, and it remains the current standard for the field: ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. This definition recognizes that the experience of pain has emotional as well as sensory features. Consensus exists among researchers and clinicians that pain has both sensory and emotional dimensions and many would add a cognitive dimension to acknowledge that pain involves attention and interpretation (Turk & Melzack, 1992).

Among older adults, pain is shown to be a common problem, but it is not a normal consequence of aging (Gagliese & Melzack, 1997). Prevalence rates between 40.7% (for hip or knee pain among persons aged 65 and over) (Dawson et al., 2004) and 73.5% (any painful area out of 10 among persons aged 65 and over) (Miro et al., 2007) are found in population-based samples of older adults. The large variation in prevalence rates between studies may be due to the fact that many different questionnaires were used to assess pain in (different) specific parts of the body. Pain can have large consequences for the quality of life. Better understanding of the relationship between pain and several aspects of social, cognitive, emotional and physical functioning is of particular importance.

Measurement instruments in LASA
I) At LASA-B, LASA-C, LASA-D, LASA-E, LASA-2B, LASA-F, LASA-G, LASA-H, LASA-3B, and LASA-I data on pain were gathered by self-administered questionnaires which subjects were asked to fill in after the face-to-face main interview. (As an exception data at LASA-MB - the Migrant-wave - were gathered during the medical interview.) Because of this procedure, the response on the pain questionnaire is relatively low. Furthermore, self-reports inform on subjective pain and consequently they do not distinguish a sensory difference from a cognitive or emotional response difference. Furthermore, the pain measurements in LASA assessed overall body pain rather than pain in specific parts of the body. The questionnaire used to assess pain did not include questions about the severity or the chronicity of the pain. As a result, no conclusions about any association with pain severity and chronicity can be made. However, the fact that pain was assessed by a questionnaire which contained questions about pain in situations and activities relevant to daily life (standing, walking, sitting and changing position) favours the use of the subscale of the Nottingham Health Profile questionnaire to assess pain.

Items
The pain questionnaire included the following 6 items:

1) ‘I am in pain when I am standing’
2) ‘I find it painful to change position’
3) ‘I am in pain when I am sitting’
4) ‘I am in pain when I walk’
5) ‘I have unbearable pain’
6) ‘I am in constant pain’

Response categories were:

1) Yes
2) No

Scores on the items can be found in LASAB115, LASAC115, LASAD115, LASAE115, LAS2B115, LASAF115, LASAG115, LASAH115, LAS3B115 / LASMB115, LASAI115, respectively.

Scale score
Based on a subscale from the Nottingham Health Profile (Hunt et al, 1985), a pain scale was constructed. All items were included, except for item 5 (‘I have unbearable pain’). Item 5 negatively affects the internal consistency of the scale; the correlation with the other items is relatively low. In addition, in factor analysis, item 5 showed to explain only a small percentage of the variance. After recoding the response category ‘no’ from 2 to 1 and the category ‘yes’ from 1 to 2, sum scores were calculated (ranging from 5 (no symptoms of pain) - 10 (5 symptoms of pain)).

Sum scores were calculated in two different ways. First, sum scores were calculated for respondents with valid data on all items. Furthermore, sum scores were computed for respondents with one missing value too. In the latter case, for every respondent, cross-sectional imputation of the missing items was performed based on the mean of the other items of the respondent. At all waves, the internal reliability indexed by Cronbach’s alpha was high (a = 0.83 (B), a = 0.81 (C), a = 0.83 (D), a = 0.81 (E), a = 0.83 (F)).

Scale scores can be found in LASAB315, LASAC315, LASAD315, LASAE315, LAS2B315, LASAF315, LASAG315, LASAH315, LAS3B315, LASMB315, LASAI315, respectively.

In analyses, it has been shown to be useful to dichotomize (no symptoms of pain (5) versus symptoms of pain (6 - 10)) and/or to trichotomize (no symptoms of pain (5), some symptoms of pain (6 or 7) and many symptoms of pain (> 7)) the pain scale. Using the score dichotomized or trichotomized, it can be decided to include respondents with one or more missing items if that does not influence the results.

II) At LASA-E, in the medical interview, the Qualeffo-41 (quality of life questionnaire) and a pain drawing were included.

Questionnaires
LASAB115 / LASAC115 / LASAD115 / LASAE115 / LAS2B115 / LASAF115 / LASAG115 / LASAH115 / LAS3B115 / LASMB115 / LASAI115 (self-administered questionnaire, in LASMB115 medical interview: in Dutch);

Variable information
LASAB115 / LASAC115 / LASAD115 / LASAE115 / LAS2B115 / LASAF115 / LASAG115 / LASAH115 / LAS3B115 / LASMB115 / LASAI115;
LASAB315 / LASAC315 / LASAD315 / LASAE315 / LAS2B315 / LASAF315 / LASAG315 / LASAH315 / LAS3B315 / LASMB315 / LASAI315 (scaled scores)
(pdf)

Availability of information per wave1:

 

B

C

D

E


2B*

F

G

H



3B*

MB* I*

Subjective pain

Sa

Sa

Sa

Sa 

Sa 

 Sa

Sa

Sa 

Sa 

Me  Sa 

1 More information is available on:
http://www.lasa-vu.nl/data/lasa/sampleLASAdatacollection.html

* 2B=baseline second cohort;
   3B=baseline third cohort;
   MB=migrants: baseline first cohort (Under Construction);
   I=Under Construction

Sa=data were collected in self-administered questionnaire
Me=data were collected in medical interview

Previous use of pain data in LASA
As reported in previous studies (e.g. Miro et al., 2007; Adamson et al., 2006), the prevalence rates of pain are higher in women than in men among the participants of LASA (e.g. at the B-cycle, 25.6% of the men and 39.7% of the women reported any pain).
In LASA, the relation between pain and depression was examined. In cross-sectional and longitudinal studies, pain was studied both as a risk factor for depression and as a consequence of depression (e.g. Beekman et al, 1995; Geerlings et al, 2002).
Furthermore, the association between obesity and pain has been studied within LASA. Obesity was shown to be associated with both the prevalence and the 6-year incidence of pain (Heim et al., 2008).

References

  1. Adamson J, Ebrahim S, Dieppe P, Hunt K. Prevalence and risk factors for joint pain among men and women in the West of Scotland Twenty-07 study. Ann Rheum Dis. Apr 2006;65(4):520-524.
  2. Beekman ATF, Kriegsman DMW, Deeg DJH, Van Tilburg W (1995). The association of physical health and depression in the older population: age and sex differences. Soc Psychiatry Psychiatr Epidemiol 30, 32-38.
  3. Dawson J, Linsell L, Zondervan K, et al. Epidemiology of hip and knee pain and its impact on overall health status in older adults. Rheumatology (Oxford). Apr 2004;43(4):497-504.
  4. Gagliese L, Melzack R. Chronic pain in elderly people. Pain. Mar 1997;70(1):3-14.
  5. Geerlings SW, Twisk JWR, Beekman ATF, Deeg DJH, Van Tilburg W (2002). Longitudinal relationship between pain and depression in older adults: sex, age and physical disability. Soc Psychiatry Psychiatr Epidemiol 37, 23-30.
  6. Heim N, Snijder MB, Deeg DJ, Seidell JC, Visser M. Obesity in Older Adults Is Associated With an Increased Prevalence and Incidence of Pain. Obesity (Silver Spring). Sep 11 2008.
  7. Hunt SM, McEwen J, McKenna SP (1985) Measuring health status: a new tool for clinicians and epidemiologists. J R Coll Gen Pract 35, 185-188.
  8. Miro J, Paredes S, Rull M, et al. Pain in older adults: a prevalence study in the Mediterranean region of Catalonia. Eur J Pain. Jan 2007;11(1):83-92.
  9. Mobiliy PR, Herr KA, Clark MK, Wallace RB (1994) An epidemiologic analysis of pain in the elderly. Journal of Aging and health 6, 139-206.
  10. Turk DC, Melzack R (eds) (1992) Handbook of pain Assessment. Guilford Press, New York.