199: Onset of Chronic Pain Among US Older Adults: A Longitudinal Study of Nationally Representative Data

Topic: Clinical Science

Please choose one of the following: Non-specific to any diagnosis

Please choose one to three of the following: Epidemiology, Pain in Special Populations

Background and Aims: Chronic pain affects 38% of older adults in the United States (US)[1] and is associated with significant disability, poorer aging outcomes, and accelerated cognitive decline[2-4]. The prevalence of chronic pain in older adults is expected to rise, given that the population of older adults and rates of multimorbidity are increasing[5,6]. Despite this growing public health burden, relatively little is known about the onset of chronic pain and its downstream consequences in later life. Therefore, the aims of this study were to examine consequences of the onset of chronic pain among US older adults.

Methods: A nationally representative sample of U.S. adults aged ≥65 was recruited to study chronic pain and aging. Participants completed questionnaires at enrollment, 6, and 12 months. A single-item screener identified participants with chronic pain (pain on more than half the days in the past 3 months) at each assessment. Analyses were conducted among participants who reported no chronic pain at enrollment (N=654). Among participants who developed chronic pain at subsequent assessments, pain intensity and disability (Graded Chronic Pain Scale), comorbidity burden (Self-Reported Comorbidity Questionnaire; SCQ) and quality of life (PROMIS Global Health) were assessed at each follow-up assessment.

Results: Among participants with no chronic pain at enrollment, 23.2% reported chronic pain during at least one follow-up assessment. Participants who reported the onset of chronic pain at 6 months that persisted through 12-month follow-up reported the greatest increases in pain intensity and pain-related disability over the study period, followed by those who reported new onset chronic pain at 12-month follow-up. Participants who reported chronic pain onset at 6 months that persisted through 12 months reported the greatest declines in physical and mental health-related quality of life. These findings persisted after controlling for relevant sociodemographic and clinical characteristics.

Conclusions: Nearly one quarter of older adults without chronic pain at enrollment developed chronic pain over one year, with substantial heterogeneity in trajectories and outcomes. Persistent pain beginning early in follow-up was associated with the greatest worsening in pain intensity, disability, and physical and mental health–related quality of life, independent of sociodemographic and clinical characteristics. These findings underscore the clinical importance of early pain onset as a marker of risk. They highlight a critical window for timely identification and intervention to prevent pain persistence and mitigate downstream functional and quality-of-life declines in older adults.

References: 1. LaRowe LR, Miaskowski C, Miller A, et al. Prevalence and Sociodemographic Correlates of Chronic Pain Among A Nationally Representative Sample of Older Adults in the United States. J Pain. 2024:104614. doi:https://doi.org/10.1016/j.jpain.2024.104614

2. Domenichiello AF, Ramsden CE. The silent epidemic of chronic pain in older adults. Prog Neuropsychopharmacol Biol Psychiatry. 2019;93:284-290. doi:10.1016/j.pnpbp.2019.04.006

3. Wilkie R, Tajar A, McBeth J. The onset of widespread musculoskeletal pain is associated with a decrease in healthy ageing in older people: A population-based prospective study. PLoS One. 2013;8(3):e59858. doi:10.1371/journal.pone.0059858

4. Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association between persistent pain and memory decline and dementia in a longitudinal cohort of elders. JAMA Intern Med. 2017;177(8):1146–1153. doi: 10.1001/jamainternmed.2017.1622

5. US Department of Health Human Services. Administration on Aging Administration for Community Living. A Profile of Older Adults. 2016.

6. Sun M, Yu B, Zhang X, et al. Trends in Multimorbidity of Multiple Noncommunicable Diseases Among Adults in the United States, 1999-2016. Lancet. 2019. doi: 10.2139/ssrn.3433889

Who is the presenting author?: Christine S. Ritchie

Who is the senior author?: Christine Miaskowski

Special Interest Group (SIG) Poster/Travel Awards: Pain in Older Persons SIG

Is your abstract directly related to the IASP 2026 Global Year theme of Neuropathic Pain?: No
Co-Authors:

• Christine S. Ritchie: MD, MSPH - Massachusetts General Hospital; Harvard Medical School
• Lisa R. LaRowe: PhD - Massachusetts General Hospital; Harvard Medical School
• Meera Srinivasan: MS - Massachusetts General Hospital
• Andrea Mayfield: MPH - NORC at the University of Chicago
• John Dombrowski: MA - NORC at the University of Chicago
• Francis J. Keefe: PhD - Duke University School of Medicine
• Alexander K. Smith: MD, MS, MPH - University of California, San Francisco; San Francisco VA Medical Center
• Bruce A. Cooper: PhD - University of California, San Francisco
• Lee-Jen Wei: PhD - Harvard T.H. Chan School of Public Health
• Christine Miaskowski: RN, PhD - University of California, San Francisco