Publications

BACKGROUND

Pain is a common symptom and significant problem for older adults; up to one half of community-dwelling older adults have pain that interferes with normal function.

OBJECTIVE

The goal of this study was to investigate the prevalence of pain among a racially and gender-balanced sample of community-dwelling older adults and evaluate sociodemographic factors associated with the reporting of pain. Both nonprescription (over-the-counter [OTC]) and prescription pain medications used by the participants and the sociodemographic factors associated with having medication prescribed were considered.

METHOD

This was a population-based, prospective, observational study. Subjects were participants in the University of Alabama at Birmingham (UAB) Study of Aging, a stratified random sample of Medicare beneficiaries who completed in-home interviews (1999-2001). Assessments included sociodemographic factors and pain; interviewers listed all prescription and OTC pain medications used. Pain medications were coded as NSAIDs, opiates, and miscellaneous pain medications. A composite ordinal measure reflecting pain severity and frequency ranged from 0 = no pain to 4 = dreadful or agonizing pain > or =4 times per week.

RESULTS

There were 1000 participants in the UAB Study of Aging (mean [SD] age, 75.3 [6.7] years; 50% black; 50% male; 51% rural residence). Seventy-four percent of the subjects reported pain; among these, 52% had daily pain, with 26% reporting dreadful or agonizing pain. Logistic regression controlling for other sociodemographic factors (age, gender, race, education, income, and marital status) found that rural residence (odds ratio [OR], 1.42; 95% CI, 1.1-1.9; P = 0.02) was significantly associated with the reporting of pain. Prescription pain medications were used by 35% of persons with pain and by 17% without pain (P < 0.001); OTC pain medications were used by 52% of persons with pain and by 45% of persons without pain (P = 0.06). Of persons reporting pain, 28% were taking neither prescription nor OTC pain medications; 16% took both and 20% took only prescription pain medications. Logistic regression found that factors associated with taking a prescription pain medication were: unmarried status (OR, 1.56; 95% CI, 1.1-2.2) and pain frequency/severity (OR, 1.39; 95% CI, 1.3-1.6). Taking an OTC pain medication was associated with lower odds of taking a prescription pain medication (OR, 0.50; 95% CI, 0.4-0.7). Age, gender, race, education, rural residence, transportation difficulty, income, and being on Medicaid were not associated with prescription pain medication use.

CONCLUSIONS

Prescription pain medication use was associated with pain frequency/severity after adjusting for sociodemographics and OTC pain medications in this study of community-dwelling older adults, suggesting that even with medications, individuals remained in pain.

The integrin alpha9beta1 is widely expressed on neutrophils, smooth muscle, hepatocytes, endothelia, and some epithelia. We now show that mice lacking this integrin have a dramatic defect in neutrophil development, with decreased numbers of granulocyte precursors in bone marrow and impaired differentiation of bone marrow cells into granulocytes. In response to granulocyte colony-stimulating factor (G-CSF), alpha9-deficient bone marrow cells or human bone marrow cells incubated with alpha9beta1-blocking antibody demonstrated decreased phosphorylation of signal transducer and activator of transcription 3 and extracellular signal-regulated protein kinase. These effects depended on the alpha9 subunit cytoplasmic domain, which was required for formation of a physical complex between alpha9beta1 and ligated G-CSF receptor. Integrin alpha9beta1 was required for granulopoiesis and played a permissive role in the G-CSF-signaling pathway, suggesting that this integrin could play an important role in disorders of granulocyte development and other conditions characterized by defective G-CSF signaling.