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The bidirectional relationship between chronic joint pain and frailty: data from the Investigating Musculoskeletal Health and Wellbeing cohort

Chaplin, Wendy J.; McWilliams, Daniel F.; Millar, Bonnie S.; Gladman, John R. F.; Walsh, David A.

The bidirectional relationship between chronic joint pain and frailty: data from the Investigating Musculoskeletal Health and Wellbeing cohort Thumbnail


Wendy J. Chaplin

Bonnie S. Millar

John R. F. Gladman

Professor of Rheumatology


Background: Pain and frailty are associated, but this relationship is insufficiently understood. We aimed to test whether there is a unidirectional or bidirectional relationship between joint pain and frailty. Methods: Data were from Investigating Musculoskeletal Health and Wellbeing, a UK-based cohort. Average joint pain severity over the previous month was assessed using an 11-point numerical rating scale (NRS). Frailty was classified as present/absent using the FRAIL questionnaire. Multivariable regression assessed the association between joint pain and frailty, adjusted for age, sex, and BMI class. Two-wave cross-lagged path modelling permitted simultaneous exploration of plausible causal pathways between pain intensity and frailty at baseline and 1-year. Transitions were assessed using t-tests. Results: One thousand one hundred seventy-nine participants were studied, 53% female, with a median age of 73 (range 60 to 95) years. FRAIL classified 176 (15%) participants as frail at baseline. Mean (SD) baseline pain score was 5.2 (2.5). Pain NRS ≥ 4 was observed in 172 (99%) of frail participants. Pain severity was associated with frailty at baseline (aOR 1.72 (95%CI 1.56 to 1.92)). In cross-lagged path analysis, higher baseline pain predicted 1-year frailty [β = 0.25, (95%CI 0.14 to 0.36), p < 0.001] and baseline frailty predicted higher 1-year pain [β = 0.06, (95%CI 0.003 to 0.11), p = 0.040]. Participants transitioning to frailty over one year had higher mean pain scores (6.4 (95%CI 5.8 to 7.1)) at baseline than those who remained non-frail (4.7 (95%CI 4.5 to 4.8)), p < 0.001. Conclusions: The bidirectional relationship between pain and frailty could lead to a vicious cycle in which each accelerates the other’s progression. This justifies attempts to prevent frailty by addressing pain and to include pain measures as an outcome in frailty studies.

Journal Article Type Article
Acceptance Date Apr 2, 2023
Online Publication Date May 5, 2023
Publication Date May 5, 2023
Deposit Date May 15, 2023
Publicly Available Date May 18, 2023
Journal BMC Geriatrics
Electronic ISSN 1471-2318
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 23
Issue 1
Article Number 273
Keywords Chronic pain, Frailty, Older people
Public URL
Additional Information Received: 19 December 2022; Accepted: 2 April 2023; First Online: 5 May 2023; : ; : Ethical approval for the Investigating Musculoskeletal Health & Wellbeing study was by the Central London Research Ethics Committee (ref.18/LO/0870 IRAS 227758). NCT03696134 registered 4/10/2018. The study was conducted according to the Declaration of Helsinki the principles of Good Clinical Practice (GCP) and the UK Policy Framework for Health and Social Care Research, 2018. Written informed consent was obtained from all participants prior to participation and they were all assured that they could withdraw their consent at any time without consequences.; : Not applicable.; : DMcW declares grant and research support from Pfizer Ltd and Lilly Ltd. DAW declares a personal financial interest in his employment by the University of Nottingham, who receive funding for his salary from the UK Government, Sherwood Forest Hospitals NHS Foundation Trust and UKRI. In the past 36months, DAW declared the following non-personal financial interests: consultancy through his employment with the University of Nottingham to Pfizer Ltd, Eli Lilly, AbbVie Ltd, Galapagos and Reckitt Benckiser Health Ltd, and GlaxoSmithKline Plc, and responsibilities for investigator-led grants outside the work in this presentation held by the University of Nottingham from Pfizer Ltd and Lilly Ltd.


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