400 Section - What are the major determinants for pain severity in community-dwelling older adults with chronic musculoskeletal pain?

Chronic musculoskeletal pain (CMP) substantially impacts the well-being of older adults worldwide, resulting in significant physical and psychosocial impairments. This study aimed to identify the major determinants of pain severity in older adults with CMP.

Design: This cross-sectional study (ChiCTR2400089069) recruited community-dwelling older adults in Hong Kong who had experienced CMP for ≥3 consecutive months. Multiple regression was performed to examine potential determinants of pain severity (assessed using Brief Pain Inventory [BPI]). Factors, including (i) demographics (age, sex and body mass index [BMI]); (ii) pain characteristics (duration of CMP and multiple CMP sites); (iii) Fried Frailty Phenotype (weight loss, exhaustion, weakness, slowness and low physical activity); (iv) psychological factors (anxiety, depression and pain catastrophising); (v) cognitive impairment; and (vi) sleep quality were assessed. The proportion of total variance explained by the model (R²) and relative importance (RI) of each determinant were estimated using the ‘rego’ package in STATA software.

Results:

A total of 180 participants (136 females; median [IQR] age: 68 [64-71] years) were recruited between November 2024 and August 2025. Of them, 142 (78.9%) reported CMP in >1 region, and 103 (57.2%) experienced moderate-to-severe pain (BPI: 4-10). The median (IQR) duration of CMP was 54 months (12-120 months). The multiple regression model explained 31% of the total variance in pain severity. The presence of multiple CMP sites was the major sub-determinant (RI: 28.9%, P< 0.001) of pain severity. Other significant sub-determinants included pain catastrophising (RI: 21.7%, P=0.003), cognitive impairment (RI: 15.8%, P=0.011) and BMI (RI: 8.3%, P=0.033).

Conclusion: Multiple painful sites, pain catastrophising, cognitive impairment and higher BMI were associated with greater pain severity in community-dwelling older adults with CMP. Comprehensive assessments, including psychological and cognitive assessments, are recommended to guide targeted treatment strategies for reducing pain severity and improving well-being in this population.