• Eric J Roseen, Rachel E Ward, Julie J Keysor, Steven J Atlas, Suzanne G Leveille, and Jonathan F Bean.
• Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA.
• PM R. 2020 Aug 1; 12 (8): 743-753.

BackgroundClarifying the relationship between pain phenotypes and physical function in older adults may enhance screening and treatment for functional decline in primary care settings.ObjectiveTo investigate the association of more severe pain phenotypes with neuromuscular impairments or mobility limitations among older community-dwelling primary care patients.DesignCross-sectional analysis.SettingThe Boston Rehabilitative Impairment Study of the Elderly.ParticipantsAdults aged 65 years or older.MethodsWe counted the number of musculoskeletal pain locations (none, single site, multisite, or widespread) using the McGill Pain Questionnaire and identified pain intensity tertiles using the Brief Pain Inventory. Neuromuscular attributes (trunk extensor muscle endurance, and leg speed, strength, strength asymmetry, and range of motion) and mobility (Short Physical Performance Battery [SPPB]) were assessed with performance-based measures. Additionally, self-reported mobility was measured on the Late Life Function and Disability Instrument (LLFDI). For neuromuscular attributes and LLFDI, scores in the lowest tertile indicated neuromuscular impairment or mobility limitations, respectively. For SPPB, a score <7 (of 12) indicated severe mobility limitations.ResultsAmong 430 participants (mean age = 77) most were female (68%), white (83%), and had either multisite (50%) or widespread (14%) pain. After adjusting for baseline characteristics, widespread pain (compared to none) was associated with slow leg speed (adjusted odds ratio, 95% confidence interval: aOR = 2.33, 1.03-5.27), limited ankle range of motion (aOR = 2.15, 1.03-4.47) and mobility limitations on LLFDI (aOR = 3.85, 1.81-8.19). Being in the highest pain intensity tertile, versus lowest tertile, was associated with poor trunk extensor muscle endurance (aOR = 2.49, 1.41-4.39), limited ankle range of motion (aOR = 2.15, 1.25-3.71), and mobility limitations on SPPB (aOR = 2.56, 1.45-4.52), and LLFDI (aOR = 4.70, 2.63-8.40).ConclusionsAmong ambulatory, older primary care patients, more severe pain phenotypes are associated with neuromuscular impairments identified on physical testing and mobility limitations on validated measures.© 2020 American Academy of Physical Medicine and Rehabilitation.

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