In this cross-sectional study, we learned the basic characteristics of chronic pain in the elderly community in Sichuan Province: 57.3% of community-dwelling older adults residing in west China were found to have chronic pain, which was mostly precipitated by chills and excessive fatigue. In addition, elderly individuals aged 60–69 years old were more likely to have mild pain. The first three common pain locations were observed to be in the legs/feet, head and abdomen/pelvis. The most affected aspect of daily life due to chronic pain was sleep. Moreover, elderly aged between 60–69 years old were less affected by chronic pain according to general activity, mood, walk, relationship and sleep. Nearly half of those with chronic pain did not use medication, and over half adopted non-drug therapy.
Surprisingly, the prevalence of chronic pain in this study was found to be significant higher than previous studies conducted by Li, Chen [6] and Si, Wang [23], which respectively reported that the prevalence of chronic pain in Chinese community-dwelling elderly were 49.8% and 41.1%. The reasons for why the prevalence was higher in this study may be the gap of economic and medical resource between East China and West China. As we can see, Li, Chen [6] and Si, Wang [23] both recruited participants from East China whose economic and medical resources are much better than that of west China, and economic status was previously observed to influence the incidence of chronic pain [29]. Moreover, Si, Wang [23] only investigated samples from the capital city owning the best economic and medical resources in Shandong Province, which could lead to a lower incidence of chronic pain.
Interms to sex, most previous studies revealed that females were more likely to have chronic pain [8, 9, 23, 30], which was inconsistent with this study. It is generally believed that females are more sensitive to pain due to their unique biological or psychological mechanisms [31, 32]. Moreover, females usually live longer than males, hence, the difference increases with aging. In this respect, this study did not find any differences in the prevalence of chronic pain according to sex, highlighting that regional and cultural differences may need to be taken into account when the relationship between sex and chronic pain be examined.
As can be seen from the data in this study, pain intensity did not increase with aging and decreased after 80 years of age. Other studies have also found a decrease in pain prevalence with age up to 85 years[33, 34],which may be related to the decreased perception of pain caused by sensory dysfunction in people over 80 years old.
This study found that elderly living with lower monthly disposable personal incomes had a higher prevalence of chronic pain, which has been confirmed by other studies[4, 35, 36]. Socioeconomic factors have been associated with worse health outcomes, for those living in poverty, low incomes haunt each financial decision, and many are unable to consistently afford prescribed interventions such as medications and ongoing visits to health care providers to manage their health[37]. Therefore, it is important for policy makers to pay more attention to the elderly population.
In our study, significant relationship between the prevalence of chronic pain and education level had not been seen, which was inconsistent with previous studies that reported a lower level of education indicated a higher incidence of chronic pain [23, 30]. They believed that patients with low education level may delay the visit or treatment due to insufficient health awareness, who fail to treat chronic pain-related illnesses early[38]. Therefore, the results of this study may imply that older people with higher education in western China still lack sufficient health awareness. However, there was also a point of view that a higher prevalence of chronic pain was observed in elderly with a lower level of education, which may be associated with the wrong perception that chronic pain are due to low education levels rather than low socio-economic status [30].
This study also found that elderly living in rural areas had a lower prevalence of chronic pain, it was not consistent with earlier findings that older people living in poorer neighborhoods are more likely to suffer from chronic pain[37, 39]. As was known to all, the economic conditions and medical conditions in urban areas are better than those in rural areas in western China, the reason for this paradoxical result may be because older people living in cities have a modern way of life, which is not healthy and leading to increased risk for kinds of chronic disease including chronic pain[40]. Studies have shown that the health care costs was higher in developed cities[41], which may lead to the lack of treatment for pain due to the heavy economic burden of disease treatment in some elderly people.
In this study, the most common pain locations were found to be in the legs/feet, head and abdomen/pelvis. The ranking of the reported pain locations was observed to vary greatly across different studies. For example, Korean elderly individuals most frequently reported back pain [42]. Moreover, elderly from the UK and Spain mostly reported lower limb pain [43, 44], while the Polish elderly mainly suffered from pain in their lumbar regions [17].
In regard to interference with daily life, chronic pain was found to interfere with it mainly in sleep, general activity and walk in this study. Si, Wang [23] also found a strong association between sleep disturbance, decreased physical activity and chronic pain in the elderly, which may be due to functional changes in the nervous system, where pain and sleep are both modulated due to long-term chronic pain [45]. It was previously found to be necessary to focus on the sleep quality of elderly with chronic pain. In terms of activity, fear of pain made them avoid exercising, daily selfcare, even any move. [46], which could endanger their independence and quality of life, with reduced levels of fitness and function leading to increased levels of disability[47]. Therefore, it is important for health care providers to educate older people to maintain and increase physical activities.
Unsurprisingly, only 29.4% of participants in this study actively sought medical help, and over 40% did not receive medication. The corresponding result was similar to that of Liberman, Freud [48], who reported that only 41.1% of elderly used medication. However, over half of participants in this study adopted non-drug therapies such as massages, hot/cold compresses, and acupuncture, which may have reduced the medication use rate, especially in elderly living in urban areas. Thus, providing easy access to medication assistance and scientific non-drug therapy guidance to elderly suffering from chronic pain may benefit and improve pain management.
There were some limitations in this study. First, this was a cross-sectional study conducted in west China, where economic and medical statuses differed from other parts of China. Thus, the representativeness of the sample was limited because the prevalence and characteristics of chronic pain were influenced by economic and medical resources. Second, precipitating factors and medication use for chronic pain may vary according to the different biological or pathological characteristics of chronic pain. In this study, we could not verify these variations, hence, researchers should be cautious in generalizing the results of the precipitating factors, pain locations and medication use conditions.