Chronic musculoskeletal pain and falls in community-dwelling older adults: The brief pain inventory shows promising discriminative validity

Background: Chronic musculoskeletal pain (CMP) and falls are common among community-dwelling older adults. Study aims were to: investigate the relationship between CMP and any (>1), single and recurrent falls (>2) in community dwelling older adults; and determine the discriminative validity of the Brief Pain Inventory (BPI) to differentiate between non-, any, and recurrent fallers. Methods: this was a cross-sectional study involving 295 community-dwelling participants (mean 77.5 ± 8.1 years, 66.4% female). CMP was assessed and classified as none (comparison group), single, and multisite (>2). The BPI severity and interference subscales were used and falls were recorded over 12 months. Data was analysed with logistic regression and receiver operator curves (ROC). Results: Over half of participants (154/295, 52.2%) had CMP (41.6% single and 58.4% multisite pain). Participants with CMP were at increased risk of recurrent falls (odds ratio [OR] 2.25, 95% CI=1.03–4.88) and this risk was highest in those with multisite CMP (OR=3.43, CI=1.34–8.65). The BPI severity subscale demonstrated good discriminative ability to differentiate between recurrent and non-fallers with an area under the curve (AUC) of 0.761, (CI=0.685–0.836); a mean score of 2.7 had a sensitivity of 78.3% and specificity of 64.6%. The AUC for the BPI interference subscale was 0.767 (CI=0.693–0.840); a mean cut off score of 2.0 had a sensitivity of 80% and specificity of 67.3%. Conclusions: Older adults with multisite CMP are at greatest risk of recurrent falls. In clinical settings, the BPI may prove useful for discriminating between recurrent and non-fallers. Implications: Pain is not yet recognised by major governing bodies (e.g. NICE, or the American or British Geriatrics Societies) as an important risk factor for falls. This research demonstrates that multisite CMP is indeed an important risk factor for falls and, in particular, recurrent falls. No author has previously considered using a pain assessment scales to identify those at risk of falls; however, this research demonstrates that the BPI may prove a useful tool to identify those most at risk from falling.