Study On The Influencing Factors And Pathways Of Pain-Related Activity Patterns In Older Adults With Chronic Musculoskeletal Pain

Objective:To investigate the current status of pain intensity,pain resilience,pain catastrophizing and pain-related activity patterns in older adults with chronic musculoskeletal pain(CMP),to analyze the influencing factors of pain-related activity patterns,and to explore the pathways of action among the four.Materials and Methods:Using convenience sampling method,298 elderly patients with chronic musculoskeletal pain were recruited from a tertiary general hospital in Chengdu from December 2021 to September 2022.Survey instruments include: general information questionnaires,Brief Pain Inventory(BPI),Pain Resilience Scale(PRS),Pain Catastrophizing Scale(PCS),and Patterns of Activity Measure-Pain(POAM-P).SPSS26.0 and PROCESS v3.5 plug-ins were used for statistical analysis.General information and questionnaire scores were analyzed using descriptive analysis.Two independent samples t-test or one-way ANOVA were used to test the differences of painrelated activity patterns in general data.Pearson correlation analysis was used to analyze the correlation between pain intensity,pain resilience,pain catastrophizing and painrelated activity patterns.Multiple stepwise regression analysis was used to explore the influencing factors of pain-related activity patterns.The PROCESS v3.5 plug-in was used to test the mediating effect of pain resilience and pain catastrophizing on pain intensity and pain-related activity patterns.Result:1.A total of 310 questionnaires were distributed in this study and 298 valid questionnaires were recovered,with an effective recovery rate of 96.1%.2.The score of overall pain intensity in older adults with CMP was(4.28±1.03).The total score of PRS was(33.16±9.74).The total score of PCS was(25.54±10.47).The total score of POAM-P from high to low were: avoidance(27.45±7.97),pacing(24.76±9.45),and overdoing(16.30±10.33).3.Correlation analyze showed that pain intensity in older adults with CMP was positively correlated with pain catastrophizing(r=0.376,P<0.001)and avoidance activity(r=0.448,P<0.001),and negatively correlated with pain resilience(r=-0.342,P<0.001)and pacing(r=-0.117,P<0.05),but not with overdoing(r=-0.106,P>0.05).Pain resilience was negatively correlated with pain catastrophizing(r=-0.616,P<0.001)and avoidance(r=-0.601,P<0.001),and positively correlated with pacing(r=0.195,P<0.001),but had no correlation with overdoing(r=0.109,P>0.05).Pain catastrophizing was positively correlated with avoidance(r=0.555,P<0.001)and overdoing(r=0.116,P<0.05),and negatively correlated with pacing(r=-0.236,P<0.001).4.Multiple stepwise regression analysis showed that gender,age,pain intensity,pain resilience and pain catastrophizing could explain 50.6% of the variation of avoidance.Age,place of residence,living conditions and pain catastrophizing could explain 14.2%of the variation of overdoing.Place of residence and pain catastrophizing can explain10.5% of the variation of pacing.5.The mediating effect analysis showed that after controlling covariates,the pain resilience and pain catastrophizing played a partial mediating role between pain intensity and avoidance activity pattern in older adults with CMP,with the mediating effect accounting for 44.16% of the total effect.Pain catastrophizing and the chain reaction of pain resilience and pain catastrophizing played a mediating role between pain intensity and pacing activity pattern,with the mediating effect accounting for 61.04% of the total effect.Conclusion:1.The pain intensity of older adults with CMP reached moderate pain level.Pain resilience and pain catastrophizing were at a medium level.The scores of pain-related activity patterns from high to low were avoidance,pacing and overdoing pattern.In general,pain intensity,pain resilience,pain catastrophizing,and selection of pain-related activity patterns in older adults with CMP could be improved.2.The influencing factors of avoidance activity patterns in older adults with CMP include age,gender,pain intensity,pain resilience,and pain catastrophizing.The influencing factors of overdoing activity patterns include age,place of residence,living conditions,and pain catastrophizing.The influencing factors of pacing activity patterns include place of residence and pain catastrophizing.Medical staff should develop specific activity management strategies for different activity patterns.3.The pain intensity of older adults with CMP can indirectly affect the avoidance and pacing pattern through the chain mediating effect of pain resilience and pain catastrophizing.Medical staff should take targeted measures to reduce pain intensity and the level of pain catastrophizing in patients and to increase the level of pain resilience,which would help patients to reduce their choice of avoidance activity pattern and promote their adoption of pacing pattern.