Chronic musculoskeletal pain among elderly in rural Tamil Nadu: Mixed-method study

OBJECTIVES: (1) To determine the prevalence of chronic pain of musculoskeletal origin at different body sites among elderly (≥60 years). (2) To study the determinants of chronic pain and the healthcare seeking behavior among elderly with chronic pain. (3) To explore the perceptions of chronic pain among elderly. MATERIALS AND METHODS: This study was done in 55 field practice villages of the Rural Health Training Centre (RHTC) of the Department of Community Medicine, SMVMCH, Puducherry. An Exploratory Mixed-Method study design, where a qualitative phase (in-depth interviews [IDI]) followed the quantitative phase (Survey). A representative sample of 850 respondents was selected by two-stage cluster sampling. A trained investigator did a house-to-house visit and interviewed selected elderly respondents by using predesigned and pretested questionnaire. The intensity of chronic pain was measured using the Functional Rating Scale and Numeric Rating Scale. The manual content analysis was done for qualitative data. Multiple logistic regression was performed on quantitative data. RESULTS: Qualitative data were described under two broad themes: (1) perceptions of elderly people about chronic pain and 2) healthcare seeking and coping mechanisms. Prevalence of chronic pain among the elderly respondents was found to be 47.6%. Most common site for chronic pain was knee joint (64.5%) followed by a low backache (21.7%). Most of the older people with chronic pain had mild-to-moderate and tolerable pain. Two predictors for chronic pain were the age of the respondent (adjusted OR -1.03, 95% CI = 1.01–1.05) and the presence of at least one chronic morbidity (adjusted OR -1.37, 95% CI = 1.03–1.82). CONCLUSIONS AND RECOMMENDATIONS: Since the chronic pain was found to be associated with aging and the presence of at least one of the chronic morbidities, it is crucial for treating community physicians to consider the comorbid conditions while managing chronic pain in elderly. Considering the complex nature of chronic pain in old age, the primary care physician should be trained in drug and context-specific nondrug interventions to address the biomedical causes and other cognitive-behavior factors, respectively, through active support from their family and neighborhood.