Frailty appeared to explain pain-management patterns better than age alone in adults with chronic non-cancer pain.
Evidence
This cross-sectional community study of 455 adults linked a 31-item with NSAID self-medication, multiple analgesic classes, nonpharmacological care, and poorer baseline pain control.
Caveat
Because the design was observational and cross-sectional, it cannot show whether frailty causes different prescribing, self-medication, or pain-control patterns.
Simplified
BACKGROUND: Chronic pain is a prevalent and disabling condition whose management becomes increasingly complex with aging and frailty. While chronological age often guides clinical decisions, frailty offers a more biologically grounded approach.
AIMS: We sought to examine the independent associations of chronological age, frailty, and sex with pain management variables in a community-based adult population.
METHODS: A cross-sectional study was conducted in 455 adults with chronic non-cancer pain. Frailty was assessed using a 31-item (FI) on the basis of the deficit accumulation model. A total of 169 pain-related variables were collected. Multivariable regression models were used to explore associations between age, FI, sex, and pain management outcomes.
RESULTS: Frailty was independently associated with nonsteroidal anti-inflammatory drug (NSAID) self-medication (odds ratio [OR] 1.03, 95% confidence interval [CI]: 1.01-1.04), greater use of nonpharmacological interventions (sr = 0.13), consumption of multiple analgesic classes (including paracetamol, opioids, and adjuvants), and absence of baseline pain control (OR 0.96, 95% CI 0.93-0.98). In contrast, older age was the main negative predictor of NSAID and anxiolytic prescriptions and physiotherapy use. Notably, frailty and age showed opposite associations for several outcomes, including number of prescribed analgesics and healthcare utilization.
CONCLUSIONS: Frailty, as a proxy for biological age, was more strongly associated with pain management patterns than chronological age. Sole reliance on age may lead to undertreatment and ageist biases. These findings should, however, be interpreted with caution given the cross-sectional observational design, which precludes causal inference. Incorporating frailty into pain care strategies may nonetheless support more personalized, effective, and safer management across the adult lifespan.
Key numbers
1.03
Increase in NSAID self-medication odds
Odds Ratio for NSAID self-medication associated with frailty
1.13
Average number of prescribed
Mean number of prescribed to participants
23.5%
Proportion of participants with adequate pain control
Percentage of participants reporting adequate pain control at baseline
Full Text
We can’t show the full text here under this license.
Declarations. Conflict of interest: PMS, LLL and JCMC declare that they have no conflicts of interest to disclose. MKA reports research grants from Sanofi, GSK, Pfizer and Merck, unrelated to the present study. Olga Theou, with Kenneth Rockwood, have asserted copyright of the Pictorial Fit–Frail Scale, which is made freely available for education, research and not-for-profit healthcare. Licenses for commercial use are facilitated through the Dalhousie Office of Commercialization and Industry Engagement. This frailty tool was not used in the present study. Sponsor’s role: No sponsors participated in the design, methods, data analysis, or preparation of this manuscript. Ethical approval: This study was approved by the Santiago-Lugo Research Ethics Committee and the Spanish Drug Agency (AEMPS) (protocol LAO-PAR-2018-01). All procedures were conducted in accordance with the ethical standards of the Declaration of Helsinki and the principles outlined in the Belmont Report, including respect for persons, beneficence, and justice. Written informed consent was obtained from all participants prior to inclusion. Participants were informed of the study’s objectives, the voluntary nature of their participation, and the anonymization of their data. No personal identifiers were retained in the final dataset. Consent to participate and for publication: All participants provided written informed consent to participate in the study and for publication of anonymized data. Data availability statement: The datasets generated and analyzed during the present study are available from the corresponding author upon reasonable request. Code availability: No custom code was generated or used for this study. Statistical analyses were conducted using IBM® SPSS® Statistics, version 28.0.1.1. Author contributions: All authors have reviewed and approved the final version of this manuscript. PMS led the data collection efforts. The study concept and design were developed collaboratively by PMS, LLL, JMC, MKA and OT. PMS, OT and MKA were responsible for the development of the frailty index and the statistical analysis. PMS drafted the manuscript, with all authors contributing to critical revisions and enhancing the intellectual content of the paper.
