Abstract

INTRODUCTION

The world population has been going through a fast and gradual aging process¹1. Programa das Nações Unidas - PNUD. Atlas do Desenvolvimento Humano no Brasil 2003. Disponível em http://www.pnud.org.br/atlas. (Acessado em maio de 2010).
http://www.pnud.org.br/atlas... . According to this tendency, population aging is a reality in Brazil. According to data from the last demographic census conducted by the Brazilian Institute of Geography and Statistics (IBGE) in 2010, the number of elderly people (60 years old or more) represented 11.3% of the Brazilian population²2. Instituto Brasileiro de Geografia e Estatística - IBGE. Sinopse do Censo Demográfico de 2010/2011. Disponível em http://www.ibge.gov.br/home/estatistica/populacao/censo2010/default_sinopse.shtm. (Acessado em maio de 2013).
http://www.ibge.gov.br/home/estatistica/... .

This change in the Brazilian age structure is directly related to the epidemiological transition, because the older the population gets, the higher the prevalence of chronic health problems. Among the consequences that demographic transition and longevity bring to society, pain is one of the most significant ones; in many cases, chronic pain is a major complaint of individuals, and considerably interferes in the quality of life of the elderly³3. Dellaroza MS, Pimenta CA, Matsuo T. Prevalence and characterization of chronic pain among the elderly living in the community. Cad Saúde Pública 2007; 23(5): 1151-60..

In a temporal context, pain can be classified as acute or chronic. Acute pain is associated with body injury; it lasts little and disappears when the injury is healed. Chronic pain, on the other hand, is persistent and recurrent, and is not necessarily associated with body injury⁴4. Souza JB. Poderia a atividade física induzir analgesia em pacientes com dor crônica? Rev Bras Med Esporte 2009; 15(2): 145-50.. It is considered to be a complex and biopsychosocial event, configured as a public health problem. It demands a multidisciplinary approach⁵5. Rull M. Abordaje multidisciplinar del dolor de espalda. Rev Soc Esp Dolor 2004; 11(3): 119-21..

The prevalence of chronic pain in studies involving the elderly is very diverse, depending on the characteristics of the study population and the used methodology. In international studies, the prevalence of chronic pain ranges from 28.9 to 59.3%⁶6. Jakobsson U, Klevsgård R, Westergren A, Hallberg IR. Old people in pain: a comparative study. J Pain Symptom Manage 2003; 26(1): 625-36.

7. Yu HY, Tang FI, Kuo BI, Yu S. Prevalence, interference, and risk factors for chronic pain among Taiwanese community older people. Pain Manag Nurs 2006; 7(1): 2-11.^-88. Catàla E, Reig E, Artés M, Aliaga L, López J, Segú J. Prevalence of pain in the Spanish population: telephone survey in 5000 homes. Eur J Pain 2002; 6(2): 133-40., while in Brazil this prevalence ranges from 29.7 to 62.2%³3. Dellaroza MS, Pimenta CA, Matsuo T. Prevalence and characterization of chronic pain among the elderly living in the community. Cad Saúde Pública 2007; 23(5): 1151-60.^,99. Dellaroza MS, Furuya RK, Cabrera MA, Matsuo T, Trelha C, Yamada KN, et al. Caracterização da dor crônica e métodos analgésicos utilizados por idosos da comunidade. Rev Assoc Med Bras 2008; 54(1): 36-41.^-1010. Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. Dor crônica em idosos residentes em São Paulo, Brasil: prevalência, características e associação com capacidade funcional e mobilidade (Estudo SABE). Cad Saúde Pública 2013; 29(2): 325-34.. A cross-sectional study suggests that increasing chronic pain is mainly associated with the female gender, older age and low socioeconomic status¹¹11. Blyth FM, March LM, Brnabic AJ, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain 2001; 89(2): 127-34.. Lower prevalence of chronic pain has been associated with having a paid job³3. Dellaroza MS, Pimenta CA, Matsuo T. Prevalence and characterization of chronic pain among the elderly living in the community. Cad Saúde Pública 2007; 23(5): 1151-60., high schooling levels and socioeconomic conditions, as well as the regular practice of exercises¹²12. Turner JA, Franklin G, Fulton-Kehoe D, Egan K, Wickizer TM, Lymp JF, et al. Prediction of chronic disability in work-related musculoskeletal disorders: a prospective, population-based study. BMC Musculoskel Disord 2004; 5(1): 14..

Despite the considerable negative influence of chronic pain on the quality of life of the elderly, which configures a public health problem, in our country only a few population-based epidemiological studies have addressed this subject. In Santa Catarina, this is the first analysis about this theme, and can be a base for other studies to emerge, thus contributing with the diffusion of such knowledge. Therefore, the objective of this study was to estimate the prevalence of chronic pain and its association with the socioeconomic and demographic situation, as well as the level of physical activities during leisure time in the elderly population of Florianópolis, Santa Catarina.

METHODS

This is a cross-sectional epidemiological study conducted with the data from the project "Condições de Saúde da População Idosa do Município de Florianópolis, Santa Catarina: Estudo de Base Populacional" (EpiFloripa Idoso 2009-2010).

The study was carried out in the urban zone of the city of Florianópolis, capital of the state of Santa Catarina. Florianópolis is located in the center-east region of the state, and most of the city (97.23%) is located in the island of Santa Catarina. According to the United Nations, the city presented municipal Human Development Index (M-HDI) of 0.847, in 2010, thus holding the third position among all Brazilian cities¹1. Programa das Nações Unidas - PNUD. Atlas do Desenvolvimento Humano no Brasil 2003. Disponível em http://www.pnud.org.br/atlas. (Acessado em maio de 2010).
http://www.pnud.org.br/atlas... .

According to the data from the last demographic census conducted by IBGE, the city's life expectancy at birth is 79.1 years old, and total fertility rate is 1.4 children per woman²2. Instituto Brasileiro de Geografia e Estatística - IBGE. Sinopse do Censo Demográfico de 2010/2011. Disponível em http://www.ibge.gov.br/home/estatistica/populacao/censo2010/default_sinopse.shtm. (Acessado em maio de 2013).
http://www.ibge.gov.br/home/estatistica/... . The estimated population in Florianópolis in 2009 was of 408,163 inhabitants, and 44,460 were aged 60 years old or more (18,844 male and 25,616 female participants), thus representing 10.9% of the total population¹³13. Instituto Brasileiro de Geografia e Estatística - IBGE. Estimativas populacionais para o TCU. Estimativas da população para 1º de julho de 2009 2009. Disponível em http://www.ibge.gov.br/home/estatistica/populacao/estimativa2009/POP2009_DOU.pdf (Acessado em junho de 2010).
http://www.ibge.gov.br/home/estatistica/... . The study population was constituted by male and female elderly people, aged 60 years old or more, living in the urban zone of Florianópolis, Santa Catarina. For sample calculation, the following parameters were used: the population was comprised of 44,460 elderly people, prevalence for the unknown outcome (50%), sampling error 4 percentage points and 95% confidence interval (95%CI). The sample was multiplied by 2 because of the design effect of the study (deff), plus 20% of predicted loss and 15% for studies of association, accounting for 1,599 individuals.

For this investigation, the sample calculation was conducted afterwards, by considering the 51.4%³3. Dellaroza MS, Pimenta CA, Matsuo T. Prevalence and characterization of chronic pain among the elderly living in the community. Cad Saúde Pública 2007; 23(5): 1151-60. prevalence of chronic pain among the elderly, with 4 percentage points as margin of error, 95%CI and design effect of 2, plus 20% for eventual loss and 15% for studies of association, resulting in a minimum sample of 1,029 individuals. Since this study was part of the EpiFloripa Idoso, the highest calculated sample was used. A two-stage cluster sampling was adopted for this study. In the first stage, the 420 urban census sectors of the city were placed in increasing order according to monthly average income of the head of the family, by systematically raffling 80 of these sectors (8 sectors in each income decile).

The units of the second stage were the households. One stage was necessary to update the number of households in each sector (listing), once the most recent census had been conducted in 2000. The study supervisors visited the raffled census sectors and started counting the inhabited households, by following the guidelines of IBGE. The number of households ranged from 61 to 725. In order to decrease the coefficient of variation in the number of households per sector, sectors with less than 150 households were clustered, and sectors with more than 500 households were divided, by respecting the corresponding income decile, which resulted in 83 census sectors. The initial coefficient of variation was 52.7% (n = 80 sectors), and the final one was 35.5% (n = 83 sectors).

According to data from IBGE¹⁴14. Instituto Brasileiro de Geografia e Estatística - IBGE. Perfil dos Idosos responsáveis pelos domicílios no Brasil 2000. Disponível em http://www.ibge.gov.br/home/estatistica/populacao/perfilidoso/default.shtm (Acessado em junho de 2010).
http://www.ibge.gov.br/home/estatistica/... , the estimation was that 60 households should be visited per sector to find 20 elderly people. Households were raffled systematically, and all elderly people living in these places were invited to participate in the study. Due to the availability of financial resources, the estimation involved 23 interviews per census sectors, thus enabling the variability of the sample; therefore, 1,911 elderly people were eligible for the study. The non-response rate was of 10.9%, which led to a final sample of 1,705 elders who were effectively interviewed. Institutionalized elderly people were excluded from this study.

Loss was considered when interviews were not conducted after four attempts (at least on in the evening and one on the weekend). Refusals involved subjects refusing to answer the questionnaire, and replacements were not admitted. Data collection was conducted by properly trained female interviewers, by means of a structured questionnaire with pre-codified questions applied in a face-to-face interview, by using the Personal Digital Assistants (PDA), after the conduction of a pre-test and a pilot-study in sectors that were not part of the study. The consistency of data and quality control were verified every week by a telephone survey reduced in 10% of the randomly selected interviews.

The outcome or dependent variable of this study was the prevalence of chronic pain in the elderly population of Florianópolis, Santa Catarina. Therefore, a structured questionnaire about chronic pain was applied with five questions¹⁵15. Perez C, Galvez R, Huelbes S, Insausti J, Bouhassira D, Diaz S, et al. Validity and reliability of the Spanish version of the DN4 (Douleur Neuropathique 4 questions) questionnaire for differential diagnosis of pain syndromes associated to a neuropathic or somatic component. Health Qual Life Outcomes 2007; 5: 66., and chronic pain was considered when it lasted six months or more, being continuous or recurrent, as established by the International Association for the Study of Pain (IASP)¹⁶16. Merskey H, Bogduk N (eds). Task Force on Taxonomy of the International Association for the Study of Pain. Classification of chronic pain: descriptions of chronic pain syndromes and definition of pain terms. Seattle: IASP; 1994.. The elderly people were asked about the sensation of pain on most days (yes/no); for how long (< 3 months, between 3 and 6 months and > 6 months); feeling pain in several parts of the body in the past month, for instance, back, legs, arms, neck or head (yes/no); if the pain lasted for more than 15 days (yes/no); and, also, in a pain scale, in which zero represented absence of pain, and one hundred, maximum bearable pain, how the person assessed pain in the past week. Considering the subjective aspect of the question about chronic pain, all of the interviews answered by an informer or a caretaker were excluded from the analysis.

The control or independent variables were: sex, age group (60 - 69; 70 - 79; 80 years old or more); marital status (married/with a partner, single/divorced, widower); schooling (0 - 4; 5-8; 9 - 11; 12 years or more); family income in quartiles (1^st quartile: ≤ R$ 327.50, 2^nd quartile: R$ 327.50 to R$ 700.00, 3^rd quartile: R$ 700.00 to R$ 1,500.00, 4^th quartile: > R$ 1,500.00); having a paid job (yes/no); worse, similar or improved economic status in comparison to the time they were 50 years old. The level of physical activity during leisure time was measured by the long version of the International Physical Activity Questionnaire (IPAQ), adapted and validated for the elderly people in Brazil¹⁷17. Benedetti TB, Mazo GZ, Barros Md. Aplicação do Questionário Internacional de Atividades Físicas para avaliação do nível de atividades físicas de mulheres idosas: validade concorrente e reprodutibilidade teste-reteste. Rev Bras Ciênc Mov 2004; 12(1): 25-34.. Elderly people who practiced at least 150 minutes a week of physical activity during leisure time were classified as being physically active; those who practiced less than 150 minutes of physical activity during leisure time were classified as insufficiently active in this domain¹⁸18. Nelson ME, Rejeski JW, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116(9): 1094-105..

All of the study variables were descriptively analyzed by means of absolute and relative frequency. Descriptive statistics included calculations of proportions and 95% confidence intervals for categorical variables. In order to test the association between the outcome (prevalence of chronic pain) and control variables (socioeconomic and demographic aspects and physical activity during leisure time), crude and adjusted analyses were conducted by the Poisson regression method, by estimating the crude and adjusted prevalence ratios with 95% confidence intervals and p-value (obtained by the Wald's test)¹⁹19. Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003; 3(1): 21.. Variables presenting p ≤ 0.05 in the crude analysis were selected to enter the adjusted model, and they remained in the model in case they reached p values ≤ 0.05 and/or were adjusted to the model. The statistical package Stata 9.0 (Stata Corp., College Station, the United States) was used, and for all of the analyses the effect of the sample design was considered by the svy command, designed to analyze data from complex samples.

The project was approved by the Research Ethics Committee of Universidade Federal de Santa Catarina, protocol n. 352/2008, on December 23, 2008. Participants were informed about the objectives of the study, and signed the informed consent form.

RESULTS

From the original sample of 1,911 elderly people eligible for the study, 1,705 individuals (89.2%) were interviewed, which corresponded to a 10.8% non-response rate (n = 206), ranging from 8.5% in the first income decile and 22.0% in the highest decile. The main reasons for losses (n = 206) were: "there was nobody home", "the elder was travelling", "scheduled with the interviewer and did not show up", "was on vacation", "was very ill", "there was an angry dog in the yard". There were 3 losses caused by hospitalization at the time of the interview, which did not affect the results. The main reasons for refusal were: "did not want to give interviews", "very long interview", "no time to answer the interview", "thinks it is a waste of time to answer interviews", "does not believe in research".

Among the 1,705 investigated elderly people, 59 interviews were excluded from the analyses for being answered by informers/caretakers, therefore accounting for 1,656 elders, out of whom 29.3% (95%CI 26.5 - 32.2) presented with chronic pain. In the study sample, women were prevalent (62.5%), as well as elderly people aged from 60 to 69 years old (51.7%), married people or those living with partners (58.9%) and with low schooling (40.0%). Most elderly people did not work (86.5%) and 48.6% mentioned that the economic status improved in comparison to when they were 50 years old. With regard to physical activities during leisure time, 68.5% of the elderly people were classified as being insufficiently active during leisure time (Table 1).

In the crude analysis, being female, with income ranging from 700 to 1,500 reais, lower schooling, having a paid job, mentioning worse economic status in comparison to the age of 50 and being physically active during leisure time were associated to the outcome. The variables age group and marital status (Table 2) were not significantly associated with chronic pain. Even though the age group variable was not significantly associated with the outcome in the crude analysis, it was maintained in the final model of the analysis because it was an important confounding variable.

In the adjusted analysis, only the variable sex, schooling, economic status and physical activity during leisure time remained associated with the outcome until the end of the analysis.

Women presented 82% more prevalence of chronic pain in relation to men (PR = 1.82; 95%CI 1.45 - 2.29), and elderly people with 0 to 4 schooling years present more prevalence of the outcome in comparison to elderly people with 12 or more schooling years (PR = 1.43; 95%CI 1.10 - 1.85). Individuals who reported worse economic status in comparison to when they were 50 years old presented 26% more prevalence of pain in comparison to those who improved their economic status (PR = 1.26; 95%CI 1.08 - 1.49). Being physically active during leisure time presented lower prevalence of chronic pain when compared to elderly who were insufficiently active (PR = 0.80; 95%CI 0.65 - 0.99) (Table 3).

DISCUSSION

The main findings of this study show important associations between the prevalence of chronic pain and socioeconomic and demographic status with physical activity during leisure time in the elderly population of the city of Florianópolis. The highest prevalence of chronic pain was significantly associated with being female, having lower schooling and worse economic status. On the other hand, being physically active during leisure time was associated with the lower prevalence of the outcome.

In this investigation, the prevalence of chronic pain in the elderly population of the city of Florianópolis was of 29.3%. Dellaroza et al.³3. Dellaroza MS, Pimenta CA, Matsuo T. Prevalence and characterization of chronic pain among the elderly living in the community. Cad Saúde Pública 2007; 23(5): 1151-60. analyzed 529 elderly people who were retired and active municipal servants in Londrina, Paraná, who reported feeling pain for at least six months, and observed prevalence of chronic pain in 51.4% of the studied population. The fact that this study was conducted with a convenience sample, that is, only municipal servants, may have contributed with the result of observing higher prevalence of chronic pain than what was found in this study.

In a cross-sectional study conducted with 219 elderly people in the city of Taipei, Taiwan, Yu et al.⁷7. Yu HY, Tang FI, Kuo BI, Yu S. Prevalence, interference, and risk factors for chronic pain among Taiwanese community older people. Pain Manag Nurs 2006; 7(1): 2-11. found a 42.0% prevalence of chronic pain. In another cross-sectional population-based study conducted in Colombia with the general population, the prevalence of chronic pain found among individuals aged more than 65 years old was of 43.8%²⁰20. Díaz CR, Marulanda MF, Sáenz X. Estudio epidemiológico del dolor crónica en Caldas, Colombia (Estudio DOLCA). Acta Méd Colomb 2009; 34(3): 96-102.. Dellaroza et al.⁹9. Dellaroza MS, Furuya RK, Cabrera MA, Matsuo T, Trelha C, Yamada KN, et al. Caracterização da dor crônica e métodos analgésicos utilizados por idosos da comunidade. Rev Assoc Med Bras 2008; 54(1): 36-41. interviewed 172 elderly people living in the region of a Basic Health Union in the north zone of Londrina, Paraná, who had felt pain for at least six months and frequent complaints of pain; the prevalence of chronic pain found in that study was of 62.2%. In this study, it is possible to observe that the sample (n = 172) was very small and not so representative, once these elderly people only correspond to people using one basic health unit of a specific location in the city of Londrina. Therefore, it does not represent the entire population of the city. It is also worth to mention that the elderly people selected for the study already complained of pain, which may have also contributed with the high percentage of chronic pain.

Dellaroza et al.¹⁰10. Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. Dor crônica em idosos residentes em São Paulo, Brasil: prevalência, características e associação com capacidade funcional e mobilidade (Estudo SABE). Cad Saúde Pública 2013; 29(2): 325-34. conducted a cross-sectional population-based study with 1,271 elderly people in the city of São Paulo and observed prevalence of chronic pain in 29.7% of the studied population; such prevalence is close to 29.3%, which corroborates the findings in this study.

In this study, it was possible to observe that the female gender was significantly associated with the higher prevalence of chronic pain, which is in accordance with findings in literature. The prevalence of chronic pain in the general population has been higher among women, in comparison to men²¹21. Kreling M, Cruz D, Pimenta CAdM. Prevalência de dor crônica em adultos. Rev Bras Enferm 2006; 59(4): 509-13.

22. Sá K, Baptista AF, Matos MA, LessaI I. Prevalência de dor crônica e fatores associados na população de Salvador, Bahia. Rev Saude Publica 2009; 43(4): 622-30.

23. Silva MC, Fassa AG, Valle NC. Dor lombar crônica em uma população adulta do Sul do Brasil: prevalência e fatores associados. Cad Saúde Pública 2004; 20(2): 377-85.^-2424. Vieira EB, Garcia JB, Silva AA, Araújo RL, Jansen RC, Bertrand AL. Chronic pain, associated factors, and impact on daily life: are there differences between the sexes? Cad Saúde Pública 2012; 28(8): 1459-67.. In international studies conducted in Spain, France and Colombia⁸8. Catàla E, Reig E, Artés M, Aliaga L, López J, Segú J. Prevalence of pain in the Spanish population: telephone survey in 5000 homes. Eur J Pain 2002; 6(2): 133-40.^,2020. Díaz CR, Marulanda MF, Sáenz X. Estudio epidemiológico del dolor crónica en Caldas, Colombia (Estudio DOLCA). Acta Méd Colomb 2009; 34(3): 96-102.^,2525. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain 2008; 136(3): 380-7., the prevalence of chronic pain was equally higher among women. In the study by Dellaroza et al.³3. Dellaroza MS, Pimenta CA, Matsuo T. Prevalence and characterization of chronic pain among the elderly living in the community. Cad Saúde Pública 2007; 23(5): 1151-60., from the analyzed sociodemographic variables, only sex was associated with the presence of chronic pain, mostly among women. In a study conducted by Leveille et al.²⁶26. Leveille SG, Zhang Y, McMullen W, Kelly-Hayes M, Felson DT. Sex differences in musculoskeletal pain in older adults. Pain 2005; 116(3): 332-8., the authors found higher prevalence of musculoskeletal pain among women. In general, elderly women have more prevalence of chronic pain in comparison to elderly men⁷7. Yu HY, Tang FI, Kuo BI, Yu S. Prevalence, interference, and risk factors for chronic pain among Taiwanese community older people. Pain Manag Nurs 2006; 7(1): 2-11., which is in accordance with the findings in this study.

Women may take the event of pain more seriously, since the multiple responsibilities and roles resulting from taking care of relatives and managing the household are reasons for them to think of pain as a threat. Besides, the meaning of pain for men and women may be influenced by social and cultural rules, which allow women to express or manifest pain, while encouraging men not to consider it. These factors should contribute with the higher number of complaints related to pain among women²¹21. Kreling M, Cruz D, Pimenta CAdM. Prevalência de dor crônica em adultos. Rev Bras Enferm 2006; 59(4): 509-13..

In this study, elderly people with lower schooling presented higher percentages of chronic pain when compared to other levels. In a study conducted by Dellaroza et al.³3. Dellaroza MS, Pimenta CA, Matsuo T. Prevalence and characterization of chronic pain among the elderly living in the community. Cad Saúde Pública 2007; 23(5): 1151-60., the authors found that elderly people who had from two to four schooling years presented higher percentage of chronic pain. In another study about the prevalence of chronic pain in the population of Salvador, individuals with lower schooling presented higher percentage of chronic pain in comparison to those with medium and high schooling²²22. Sá K, Baptista AF, Matos MA, LessaI I. Prevalência de dor crônica e fatores associados na população de Salvador, Bahia. Rev Saude Publica 2009; 43(4): 622-30.. Therefore, the low schooling is probably related to high percentages of chronic pain among the individuals.

This is an expressive result, since it reflects the social conditions of the beginning of last century, demonstrating that access to education was restricted. The educational possibilities more than half a century ago were little, and people needed to work in order to provide for their families. Considering that the schooling level has an important influence on the access to information, it can be determinant for the search for treatments, and also for self-care, since elderly people should be able to look after themselves, and knowing how to read is a contributive factor²⁷27. Celich KLS, Galon C. Dor crônica em idosos e sua influência nas atividades da vida diária e convivência social. Rev Bras de Geriatr Gerontol 2009; 12(3): 345-59..

In this investigation, elderly people who reported that their economic situation became worse when compared to when they were 50 years old presented higher percentages of chronic pain. Even though some investigations⁹9. Dellaroza MS, Furuya RK, Cabrera MA, Matsuo T, Trelha C, Yamada KN, et al. Caracterização da dor crônica e métodos analgésicos utilizados por idosos da comunidade. Rev Assoc Med Bras 2008; 54(1): 36-41.^,1212. Turner JA, Franklin G, Fulton-Kehoe D, Egan K, Wickizer TM, Lymp JF, et al. Prediction of chronic disability in work-related musculoskeletal disorders: a prospective, population-based study. BMC Musculoskel Disord 2004; 5(1): 14. mention that the percentage of chronic pain is higher among individuals from lower social classes, no studies were found that analyzed the relationship between chronic pain and economic situation at the age of 50 when compared to the current time, which shows the need for further investigations.

In this study, it was observed that being physically active during leisure time was significantly associated with lower prevalence of chronic pain. The practice of physical activities by the elderly, especially during leisure time, provides opportunities for a more active, healthy and independent life, thus contributing with the maintenance of autonomy and improved quality of life²⁸28. Cress ME, Buchner DM, Prohaska T, Rimmer J, Brown M, Macera C, et al. Best practices for physical activity programs and behavior counseling in older adult populations. J Aging Phys Act 2005; 13(1): 61-74.. In a cross-sectional study conducted with the population of Norway, the authors found 10 to 12% lower prevalence of chronic pain among individuals aged 20 - 64 years old who practiced moderate physical activities three times a week; among the older ones, depending on the intensity of the exercise, there was a 21 - 38% reduction in the prevalence of chronic pain²⁹29. Landmark T, Romundstad P, Borchgrevink PC, Kaasa S, Dale O. Associations between recreational exercise and chronic pain in the general population: evidence from the HUNT 3 study. Pain 2011; 152(10): 2241-7..

Among the strategies employed by multidisciplinar programs addressed to treating chronic pain, physical activity is one of the most used ones³⁰30. Bennett RM, Burckhardt C, Clark S, O'Reilly C, Wiens A, Campbell S. Group treatment of fibromyalgia: a 6 month outpatient program. J Rheumatol 1996; 23(3): 521-8.^-3131. Souza JB, Charest J, Marchand S. École interactionnelle de fibromyalgie: description et évaluation. Douleur et Analgésie 2007; 20(4): 213-8.. One of the mostly accepted hypotheses about the benefits of exercises for managing chronic pain is owed to the fact that its influence is related to endogenous pain control mechanisms³²32. Koltyn KF. Analgesia following exercise: a review. Sports Med 2000; 29(2): 85-98..

Some limitations of this study should be considered, especially the cross-sectional design, which does not enable causality relations between the prevalence of chronic pain and the other investigated variables with the self-reported measurements of the studied variables. However, it is not relevant to know, in this case, if the elderly presented lower prevalence for the outcome because they were physically active, or if the fact of being physically active led to lower prevalence for the outcome, because being physically active may have been beneficial both for maintaining health, thus avoiding the onset of chronic pain, and for reducing the intensity and duration of pain among the elderly who already presented with chronic pain. Among the positive aspects, the study stands out for the relevance and originality of the theme, which can be the base for other investigations, and for the fact that the sample is large and represents the elderly people of the city of Florianópolis. It is also worth to mention that the high response rate of the study contributed with its internal validity and reduced the chances of systematic errors.

CONCLUSION

The fact that women, individuals with low schooling, the ones with worse economic status and those who were insufficiently active presented higher prevalence of chronic pain among the elderly represents an important finding, which can subsidize public health policies focused on assistance for this population.

Therefore, the results suggest that campaigns addressed to preventing chronic pai should mostly be aimed at women, with low income and insufficiently active during leisure time. It is also necessary to create multidisciplinary management programs and chronic pain control, including guidance to health professionals so that they can work on preventing chronic pain and physical activities specifically addressed to the elderly population, with the objective of preventing chronic pain from being responsible for problems in the quality of life of the elderly.

References

Publication Dates

History