Abstract
Background:
Chronic pain occurs in 30% of older adults. This prevalence rate is expected to increase, given the growth in the older adult population and the associated growth of chronic conditions contributing to pain. No population-based studies have provided detailed, longitudinal information on the experience of chronic pain in older adults, the pharmacologic and nonpharmacologic strategies that older adults use to manage their chronic pain, and the effect of chronic pain on patient-reported outcomes.
Objectives:
This paper aims to describe the protocol for a population-based, longitudinal study focused on understanding the experience of chronic pain in older adults. The objectives are to determine the prevalence and characteristics of chronic pain; identify the pharmacologic and nonpharmacologic pain treatments used; evaluate for longitudinal differences in biopsychosocial factors; and examine how pain types and pain trajectories affect important patient-reported outcomes. Also included are the results of a pilot study.
Methods:
A population-based sample of approximately 1,888 older adults will be recruited from the National Opinion Research Center at the University of Chicago’s AmeriSpeak® Panel to complete surveys at three waves: enrollment (Wave 1), 6 months (Wave 2), and 12 months (Wave 3). To determine the feasibility, a pilot test of the enrollment survey was conducted among 123 older adults.
Results:
In the pilot study, older adults with chronic pain reported a range of pain conditions, with osteoarthritis being the most common. Participants reported an array of pharmacologic and nonpharmacologic pain strategies. Compared to participants without chronic pain, those with chronic pain reported lower physical and cognitive function and poorer quality of life. Data collection for the primary, longitudinal study is ongoing.
Discussion:
This project will be the first longitudinal population-based study to examine the experience and overall effect of chronic pain in older adults. Pilot study results provide evidence of the feasibility of study methods. Ultimately, this work will inform the development of tailored interventions for older patients targeted to decrease pain and improve function and quality of life.
Keywords: aging, analgesics, chronic pain, cognitive function, physical function
Chronic pain (i.e., pain that persists beyond the standard healing time or about 3 months) is estimated to affect 30% of older adults in the United States (Zelaya et al., 2020). Chronic pain is associated with frailty, mobility limitations, cognitive impairment, and decrements in quality of life (QOL; Berryman et al., 2013; Cruz-Almeida et al., 2017; Ritchie et al., 2023). While the high prevalence and burden of chronic pain represent a significant public health crisis, the Federal Pain Research Strategy (Interagency Pain Research Coordinating Committee and the Office of Pain Policy of the National Institutes of Health, n.d.) noted that “the paucity of large data sets of well-characterized patients has delayed our understanding of acute and chronic pain and development of safe and effective pain management” (p. 6). For example, among older adults, the exact prevalence of chronic pain and its associated characteristics (e.g., severity, location, aggravating and relieving factors) are not known.
Another knowledge gap is that no longitudinal studies have examined changes in pain management in the context of the opioid epidemic. In addition, information is lacking on the effects of specific pharmacologic and nonpharmacologic treatments on chronic pain outcomes in older adults. For example, guidelines recommend that clinicians limit opioid analgesic prescriptions among older adults (American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons, 2009; Centers for Disease Control & Prevention, 2016; Dowell et al., 2022). Equally noteworthy, many older adults cannot tolerate or have contraindications to nonopioid analgesics (Wongrakpanich et al., 2018). Alternative therapies (especially nonpharmacologic therapies) are less accessible to older adults because they are not affordable, not recommended by clinicians, or not available in certain communities (Garrett et al., 2021; Ritchie et al., 2020). Given the high prevalence and negative effect of chronic pain among older adults, it is surprising that no population-based longitudinal studies have done a comprehensive evaluation of pharmacologic and nonpharmacologic interventions for chronic pain among older adults or assessed for associations between treatments and substantial patient-reported outcomes (PROs; e.g., physical function, cognitive function, QOL).
In addition, research is needed to systematically evaluate the effect of a variety of biopsychosocial factors on chronic pain in older adults. As noted in the biopsychosocial (BPS) model of chronic pain (Miaskowski et al., 2020), pain is influenced by a variety of biological (e.g., sex, age, comorbidity), psychological (e.g., depression, anxiety), and social (e.g., discrimination, social support) factors. However, most research is cross-sectional and/or focused on general adult (vs. older adult) populations. For example, in terms of biological factors, a higher number of comorbid conditions is associated with the occurrence of chronic pain (Dominick et al., 2012). However, little is known about the specific conditions that increase the risk of developing pain-related morbidity over time or how the interactions between chronic pain and comorbidity influence physical and cognitive function and QOL.
In addition, while the role of psychological factors in the experience of chronic pain is well-documented, no large population-based longitudinal studies have examined how anxiety, depression, and pain-related psychological factors (e.g., pain coping, pain self-efficacy) influence changes in pain characteristics and outcomes among older adults. Equally essential, while social vulnerabilities (e.g., loneliness) increase with age (Perissinotto et al., 2012), limited information is available on how social factors influence chronic pain among older adults. Taken together, while cross-sectional studies have explored the role of select factors within the BPS model, additional research is needed to systematically evaluate the key domains and factors integral to the experience of chronic pain in older adults and how these domains influence physical function, cognitive function, and QOL.
Finally, although limited research has explored the longitudinal effects of chronic pain on specific outcomes (e.g., cognitive decline; Rouch et al., 2021; Veronese et al., 2018), no studies of older adults have done a comprehensive evaluation of how changes in the chronic pain experience (e.g., pain severity, management approaches) and associated characteristics (e.g., BPS factors) are related to changes in multiple PROs (e.g., physical function, cognitive function, QOL). Despite preliminary evidence that suggests that chronic pain may play an essential role in PROs, additional research is needed to further elucidate the effects of pain and related factors on health outcomes. The determination of the BPS factors that are associated with changes in pain trajectories; identification of subgroups of older adults with distinct pain profiles; and examination of longitudinal associations between pain profiles and changes in PROs will assist with the identification of common and distinct modifiable factors associated with more severe chronic pain and reduced function and QOL. Collectively, this knowledge will inform the development of tailored interventions that target subgroups of older adults with chronic pain.
To fill these knowledge gaps, the goal of this project is to conduct the first methodologically rigorous, population-based, longitudinal study focused on chronic pain in older adults. Specifically, among a sample of older adults with and without chronic pain, the specific aims are to: (a) determine the prevalence and characteristics (e.g., quality, severity, interference) of chronic pain as well as identify the pharmacologic and nonpharmacologic treatments used to manage chronic pain; (b) evaluate for longitudinal differences in biological, psychological, and social factors, as well as physical and cognitive function and QOL between older adults with and without chronic pain; and (c) examine how pain types and pain trajectories effect critical PROs (i.e., physical function, cognitive function, QOL). The purpose of this paper is to describe the study protocol and present initial results from a pilot study.
Methods
Study Overview and Setting
This prospective longitudinal study will follow a large population-based sample of 1,888 (±10% of target sample size) older adults, of whom 1,232 have chronic pain (i.e., pain of > 3 months duration) and 656 do not have chronic pain. Data will be collected from the same participants in three waves (i.e., at enrollment (Wave 1), 6 months (Wave 2), and 12 months (Wave 3). This 1-year follow-up period is consistent with prior longitudinal studies focused on chronic pain in older adults (e.g., Kim et al., 2018; Rapo-Pylkkö et al., 2017; Vigdal et al., 2023). In addition, this study will be the first to recruit a nationally representative sample of adults aged ≥ 65. Prior evidence suggests that a 1-year duration is sufficient to be able to detect changes in PROs in older adults, including physical/cognitive decline and QOL (e.g., Dong et al., 2018; Kahraman et al., 2021; Wearn et al., 2020). The study will use both online and telephone data collection to facilitate the engagement of segments of the population (e.g., low-income and low-literacy respondents) who are typically missed in convenience “opt-in” samples or online-only surveys.
Study Participants
Recruitment and Screening
A nationally representative sample of older adults (aged ≥ 65) will be recruited from the National Opinion Research Center (NORC) at the University of Chicago’s (NORC) internally developed AmeriSpeak® Panel. The AmeriSpeak® Panel is a probability-based panel covering over 99% of U.S. households, including a supplemental list of rural households not recorded on the U.S. Postal Service Computerized Delivery Sequence file but identified through NORC in-person fieldwork. Households are sampled with a known, nonzero probability of selection from the NORC National Frame and recruited through a rigorous process that uses mail, telephone, and in-person recruitment by field interviewers to ensure that even hard-to-reach populations are represented in the panel (for additional information, see Bilgen et al., 2018; Pedlow & Zhao, 2016; Ventura et al., 2017).
From the AmeriSpeak pool of ~3,200 older adults, NORC will identify a sample of English- or Spanish-speaking participants aligned with current population benchmarks for race, ethnicity, sex, age, education level, household income, and census region. Respondents in poor health will not be excluded unless cognitive impairment precludes informed consent. Chronic pain prevalence will be determined, and recruitment from this cohort of older adults will continue until 1,232 participants with chronic pain complete Wave 1 of the survey. A randomly selected portion of participants who do not screen positive for chronic pain will be approached for participation so that 656 participants without chronic pain complete Wave 1.
Retention
NORC employs several strategies to achieve high retention rates across waves, including frequent engagement with panelists, email reminders, and larger-than-usual incentives for follow-up waves. Based on prior work (e.g., Holman et al., 2023), a conservative 75% retention rate is projected between the enrollment survey and the Wave 2 follow-up survey (25% attrition), and an 85% retention rate between Wave 2 and Wave 3 follow-up surveys (15% attrition). The anticipated sample will include 1,415 and 1,204 respondents for Waves 2 and 3, respectively.
Data Collection
Data collection will occur over three waves: enrollment (Wave 1), 6 months (Wave 2), and 12 months (Wave 3). At each wave, all participants will be asked to report information about biological, social, and psychological factors, as well as PROs (i.e., physical function, cognitive function, QOL). At each wave, older adults with chronic pain will be asked to provide detailed information about pain characteristics (e.g., quality, severity, interference) and the use of pharmacologic and nonpharmacologic pain management approaches. Older adults without pain at enrollment will be questioned in Waves 2 and 3 about the development of chronic pain. If they develop chronic pain, they will complete the pain questionnaires.
Measures
A detailed description of the study measures is provided in the Supplemental Digital Content. In brief, a single-item chronic pain screener previously employed in the National Health Interview Survey will be used to identify participants with chronic pain (defined as pain on more than half the days in the past 3 months; Zelaya et al., 2020). Information on pain characteristics and pain management strategies will be obtained from individuals with chronic pain at each wave. In addition, information on a variety of biological (e.g., sex, age, cigarette smoking, alcohol use, comorbid medical conditions), psychological (e.g., depression, anxiety), and social (e.g., employment status, education, income, race/ethnicity, ageism, social support) factors will be obtained from all participants, regardless of chronic pain status. Among individuals with chronic pain, additional psychological factors will be assessed at each wave, including activity avoidance due to pain, pain catastrophizing, coping with chronic pain, and pain self-efficacy. Finally, PROs, including functional, cognitive, and QOL outcomes, will be evaluated in all participants at each wave. We pilot-tested our data collection methods and the measures in 123 older adults.
Data Analysis
Analyses will be done using Stata Statistical Software (Release 17; College Station, TX: StataCorp LLC.), SAS version 9.4 (SAS Institute), and Mplus (Version 8; Muthén & Muthén, Los Angeles, CA). Missing data will be handled using measure-specific instructions, multiple imputation, and analytic model specifications. In addition, throughout the analyses, nationally representative estimates will be computed by incorporating the survey design weights in our analyses.
Overall Study Objectives
For Aim 1, the weighted prevalence of chronic pain and the associated two-sided 95% confidence intervals will be calculated using the screening survey results. Prevalence estimates of chronic pain and each type of pain condition (e.g., osteoarthritis) will be stratified by age and sex. Descriptive statistics as survey-weighted means and standard deviations (or medians and interquartile ranges) for quantitative variables and survey-weighted percentages for categorical variables will be reported to examine chronic pain characteristics and treatment.
For Aim 2, multilevel regression will be used to evaluate for longitudinal differences in biological, psychological, social factors, as well as physical function, cognitive function, and QOL, over three assessments between older adults with and without chronic pain. In addition, tests of associations between significant covariates (e.g., sex) and each outcome and possible moderating effects between covariates and pain group status at enrollment or between the two groups’ change trajectories will be examined with multilevel regression. The possibility of confounding effects associated with dropouts will be examined.
For Aim 3, multilevel regression will determine which biological, psychological, and social factors at enrollment are associated with changes in the trajectories of chronic pain over 12 months. For this analysis, effects of biopsychosocial factors will be the predictors of interest rather than pain group status. In addition, as part of Aim 3, subgroups of older adults with distinct pain profiles will be identified using latent profile analysis with survey weights incorporated into the estimation. Once latent classes are identified, multilevel regression will determine how changes in the trajectories of physical function, cognitive function, and QOL are associated with these distinct pain profile classes.
Sample Size
Monte Carlo analyses were used to estimate effect sizes that could be detected, given the targeted enrollment of 1,232 participants with and 656 participants without chronic pain for the primary hypotheses of cross-level interactions (linear time by predictor) for a dichotomy with a 65%/35% split and a normally distributed quantitative predictor. Effect sizes were estimated for these effects, with power equal to .80 and a two-sided alpha of .05 for each effect. These effects were modeled, including within-person associations for the outcomes as having constant correlations of .30 across assessments. With an expected 25% attrition between enrollment and the Wave 2 follow-up and 15% attrition between Wave 2 and Wave 3 follow-ups, power analyses were carried out, allowing for attrition, for an enrolled sample of 1,035 (adjusting for unequal probability survey weights) with missing data accommodated for and allowing for the design effect.
Even with the attrition, this sample size will allow for the detection of a standardized effect of .20 (Cohen’s d, a small effect size) for the difference in linear trajectories due to a dichotomy with a 65%/35% split between the two groups. In addition, an effect of .085 (Cohen’s d, a very weak effect) can be detected for the effect of a continuous predictor on the linear change of a quantitative outcome over 12 months. These power estimations were obtained with Monte Carlo simulations with 10,000 random draws using Mplus (Version 8). Simulations were carried out with two random number seeds to ensure the results were not due to an unusual sampling model. Power estimates were obtained with 95% coverage across effects and for each random number seed.
Pilot Study
A pilot study was conducted to examine the feasibility of the proposed data collection methods. A sample of 123 older adults was recruited from NORC’s AmeriSpeak survey. Participants were asked to complete the enrollment (Wave 1) survey. Descriptive statistics were calculated, and parametric and nonparametric tests were used to evaluate between-group differences in sociodemographic characteristics and PROs.
Pilot Study Results
Participant Characteristics
Of the 123 older adults evaluated, 35% had chronic pain (Table 1). Overall, participants ranged in age from 65 to 86 years (M = 71.89), and 55.3% were female. Seventy percent completed at least a 4-year college degree, and 60.2% reported a total household income of > $60,000. No significant between-group differences were found in any sociodemographic characteristics (all p > .05).
Table 1.
Differences in Sociodemographic Characteristics Between Participants With and Without Chronic Pain
| Characteristics |
Total (N = 123) |
Chronic Pain (n = 43) |
No Chronic Pain (n = 80) |
Statistics |
|---|---|---|---|---|
|
| ||||
| n (%) | n (%) | n (%) | ||
|
| ||||
| Gender | ||||
| Female | 68 (55.3) | 20 (46.5) | 48 (60.0) | χ2 = 2.1; p = .18 |
| Race/ethnicity | ||||
| White, non-Hispanic | 111 (90.2) | 39 (90.7) | 72 (90.0) | χ2 = 5.1; p = .27 |
| Black, non-Hispanic | 6 (4.9) | 1 (2.3) | 5 (6.3) | |
| Other, non-Hispanic | 1 (0.8) | 1 (2.3) | 0 (0.0) | |
| Multiple races, non-Hispanic | 3 (2.4) | 2 (4.7) | 1 (1.3) | |
| Hispanic | 2 (1.6) | 0 (0.0) | 2 (2.5) | |
| Marital status | ||||
| Never married | 11 (8.9) | 1 (2.3) | 10 (12.5) | χ2 = 7.0; p = .07 |
| Married | 73 (59.3) | 29 (67.4) | 44 (55.0) | |
| Divorced/Separated | 28 (22.8) | 7 (16.3) | 21 (17.1) | |
| Widowed | 11 (8.9) | 6 (14.0) | 5 (6.3) | |
| Education | ||||
| Less than high school | 2 (1.6) | 1 (2.3) | 1 (1.3) | U; p = .15 |
| High school graduate or GED | 8 (6.5) | 3 (7.0) | 5 (6.3) | |
| Some college/technical school/ Associates degree | 27 (22.0) | 11 (25.6) | 16 (20.0) | |
| Bachelor’s degree | 49 (39.8) | 19 (44.2) | 30 (37.5) | |
| Post-grad/professional degree | 37 (30.1) | 9 (20.9) | 28 (35.0) | |
| Employment | ||||
| Working – as a paid employee | 27 (22.0) | 8 (18.6) | 19 (23.8) | χ2 = 5.9; p = .44 |
| Working – self-employed | 8 (6.5) | 4 (9.3) | 4 (5.0) | |
| Not working – temporary layoff | 1 (0.8) | 0 (0.0) | 1 (1.3) | |
| Not working – looking for work | 1 (0.8) | 1 (2.3) | 0 (0.0) | |
| Not working – retired | 80 (65.0) | 28 (65.1) | 52 (65.0) | |
| Not working – disabled | 5 (4.1) | 1 (2.3) | 4 (5.0) | |
| Not working – other | 1 (0.8) | 1 (2.3) | 0 (0.0) | |
| Household income | ||||
| < $30,000 | 19 (15.4) | 6 (14.0) | 13 (16.3) | U; p = .51 |
| $30,000 - $59,999 | 30 (24.4) | 8 (18.6) | 22 (27.5) | |
| $60,000 - $99,999 | 52 (42.3) | 22 (51.2) | 30 (37.5) | |
| ≥ $100,000 | 22 (17.9) | 7 (16.3) | 15 (18.8) | |
|
| ||||
| Mean (SD) | Mean (SD) | Mean (SD) | ||
|
| ||||
| Age | 71.9 (4.8) | 72.0 (5.0) | 71.8 (4.7) | t = −.19; p = .85 |
Note. Abbreviation: GED = General Educational Development diploma; U = Mann Whitney U test; SD = standard deviation.
Among participants with chronic pain, 38.1% had Grade 3 or Grade 4 chronic pain, indicating a high level of pain-related disability (Table 2). Most commonly reported pain conditions were osteoarthritis (61.9%) and back pain (58.5%). Frequently endorsed treatment approaches included over-the-counter pain relievers (86.0%), massage (35.7%), and physical, rehabilitative, or occupational therapy (30.2%). In addition, 20.9% of participants reported using opioid analgesics.
Table 2.
Pain Characteristics and Treatment Approaches for Older Adults with Chronic Pain (n=43)
| n (%) | |
|---|---|
|
| |
| Condition | |
| Chronic headaches | 4 (9.5) |
| Migraine headaches | 4 (9.8) |
| Back pain | 24 (58.5) |
| Fibromyalgia | 4 (10.0) |
| Diabetic neuropathy | 5 (12.5) |
| Osteoarthritis | 26 (61.9) |
| Rheumatoid arthritis | 4 (10.3) |
| Chemotherapy-induced peripheral neuropathy | 1 (2.5) |
| Bone pain from cancer metastasis | 0 (0.0) |
| Chronic Pain Gradea | |
| Grade 1 | 15 (35.7) |
| Grade 2 | 11 (26.2) |
| Grade 3 | 6 (14.3) |
| Grade 4 | 10 (23.8) |
| Treatment | |
| Opioid analgesics | 9 (20.9) |
| Over-the-counter pain relievers | 37 (86.0) |
| Physical therapy, rehabilitative therapy, occupational therapy | 13 (30.2) |
| Chiropractic care | 5 (11.6) |
| Cognitive behavioral therapy | 4 (9.3) |
| Chronic pain self-management program/workshop | 4 (9.5) |
| Chronic pain peer support group | 1 (2.3) |
| Yoga | 6 (14.0) |
| Tai chi | 3 (7.0) |
| Massage | 15 (35.7) |
| Meditation, guided imagery, relaxation practice | 11 (26.2) |
| CBD (Cannabidiol) | 9 (22.0) |
| THC (Tetrahydrocannabinol) | 5 (12.5) |
| Other | 23 (54.8) |
|
| |
| Mean (SD) | |
|
| |
| PEG scale | 5.0 (2.3) |
| Characteristic pain intensitya | 57.9 (16.8) |
| Pain-related disabilitya | 41.9 (28.2) |
Note. SD = standard deviation.
Graded Chronic Pain Scale (pain severity increases with grade).
Differences in PROs as a Function of Chronic Pain Status
Differences in PROs as a function of chronic pain status are displayed in Table 3. Compared to participants without chronic pain, older adults with chronic pain reported lower levels of physical function and poorer cognitive functioning. In addition, participants with chronic pain reported poorer physical and mental QOL.
Table 3.
Differences in Patient-Reported Outcomes Between Older Adults With and Without Chronic Pain
|
Total (N = 123) |
Chronic Pain (n = 43) |
No Chronic Pain (n = 80) |
Statistics | |
|---|---|---|---|---|
|
| ||||
| M (SD) | M (SD) | M (SD) | ||
|
| ||||
| Physical function | 8.0 (2.1) | 6.7 (2.1) | 8.7 (1.7) | t = 5.4, p < .001 |
| Life space level | 4.8 (0.5) | 4.8 (0.7) | 4.8 (0.5) | t = 0.5, p = .636 |
| PASEa | 151.3 (77.5) | 140.3 (82.8) | 157.3 (74.4) | t = 1.1, p = .259 |
| AFIb – Total | 7.9 (1.5) | 7.3 (1.5) | 8.2 (1.3) | t = 3.3, p = .001 |
| AFIb – Effective action | 7.7 (1.9) | 7.1 (1.8) | 8.1 (1.8) | t = 2.7, p = .007 |
| AFIb – Attentional lapses | 8.0 (1.8) | 7.3 (2.1) | 8.4 (1.4) | t = 3.0, p = .004 |
| AFIb – Interpersonal effectiveness | 8.1 (1.5) | 7.7 (1.7) | 8.2 (1.4) | t = 1.8, p = .08 |
| Global QOLc – physical health | 49.2 (8.9) | 43.5 (8.2) | 52.3 (7.7) | t = 5.9, p < .001 |
| Global QOLc – mental health | 52.9 (8.5) | 49.7 (9.3) | 54.7 (7.5) | t = 3.2, p = .002 |
Note.
PASE = Physical Activity Scale for the Elderly (uses frequency, duration, and intensity level of non-work related physical activity over the previous week to generate a score, with higher scores indicating greater physical activity)
AFI = Attentional Function Index (assesses perceived cognitive function using scales ranging from 1–10 with higher scores indicating higher function)
QOL = Quality of Life (scores reported are t-scores, with higher scores reflecting between quality of life).
Discussion
This project will be the first longitudinal, rigorous, in-depth population-based study of chronic pain in older adults; it will focus on their experiences with and overall effect of chronic pain (and not a particular pain condition). This approach is critical given that 80% of older adults have multiple chronic conditions and many older adults have multiple pain problems (Gerteis et al., 2014; Nahin, 2015). The proposed study will provide insights into the effect of recent practice changes in pain management and how these changes influence older adults’ management of their pain. Of particular importance, this longitudinal study will evaluate the effect of chronic pain and pain management strategies on extremely important PROs (i.e., physical function, cognition function, QOL) over 12 months.
In addition, based on the BPS model of chronic pain for older adults (Miaskowski et al., 2020), this study will be the first to provide a detailed characterization of the biological, psychological, and social factors that influence the pain experience of older adults. This evaluation will include several crucial factors, such as fear-avoidance beliefs, pain coping, catastrophizing, self-efficacy, and ageism. The comprehensive information on pain, associated BPS factors, management strategies, and PROs obtained from this study will guide the development of tailored interventions to improve patient outcomes and inform policy recommendations.
The pilot study’s results provide evidence of the feasibility of administering the planned assessment battery. From the AmeriSpeak® Panel, a sample of older adults with and without chronic pain were recruited to pilot test the enrollment survey. A wide range of pain conditions and management approaches were endorsed among participants with chronic pain. Pilot study results revealed differences in PROs as a function of chronic pain status, such that individuals with chronic pain reported poorer outcomes. These findings underscore the magnitude of evaluating PROs as a function of pain status, type, and trajectory and demonstrate the feasibility of the proposed data collection methods. The larger study will include an oversample of older adults with (vs. without) chronic pain to increase variability in pain characteristics allowing for the identification of subgroups with distinct pain profiles and an examination of associations between pain profiles/trajectories, treatment approaches, and PROs.
Limitations
This project has many strengths, including its longitudinal design; focus on older adults; and inclusion of both online and telephone data collection. It will allow us to engage segments of the population such as low-income and low-literacy respondents. However, the pilot study sample was predominantly White and well-educated; these findings led to the adoption of additional strategies by AmeriSpeak to increase the diversity of the sample. Moreover, AmeriSpeak will continue to employ methods that are known to increase recruitment and retention of population segments that are typically underrepresented in probability-based household panels (e.g., Bilgen et al., 2018; Pedlow & Zhao, 2016; Ventura et al., 2017) and will incorporate survey design weights to generate nationally representative estimates. Second, this study is limited to self-report data collection and is unable to capture every facet of chronic pain or provide an in-depth understanding of pain medication use and/or underlying mechanisms. However, study results will provide a critical scientific starting point for understanding this devastating problem.
Conclusion
Ultimately, this research will advance patient care by informing future research and clinical work aimed at improving pain management, as well as overall function and QOL, among older adults with chronic pain. Findings from this study will provide important information critical for developing and testing of novel interventions to improve chronic pain management and PROs in this growing and highly vulnerable population of older adults with chronic pain. Knowledge gained will provide insight into the role of pharmacologic and nonpharmacologic pain management approaches in PROs and have the potential to influence standards of care and treatment recommendations.
Supplementary Material
Acknowledgments
The National Institute on Aging of the National Institutes of Health (NIH; Award No. R01AG064947) supported the research reported in this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board at Massachusetts General Hospital (#2021P002387).
Footnotes
The authors have no conflicts of interest to report.
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