Pain thresholds in elderly individuals: a cross-sectional observational study of the influence of gender and chronic non-cancer pain
Limiares de dor em idosos: um estudo observacional transversal sobre a influência do gênero e da dor crônica não cancerígena
Áquila Lopes Gouvêa, Pedro Adde Anuardo, João Paulo Consentino Solano, Ângela Maria Sousa, Hazem Adel Ashmawi
Abstract
Background
The older population is growing, and it is estimated that, by 2050, people aged 60-years or more will have reached two billion. The increased life expectancy has led to a higher
incidence of chronic degenerative diseases, contributing to increased pain complaints. This study aims to compare the pain threshold after mechanical stimulation in older adults according to gender and presence or absence of chronic pain and find the prevalence and intensity of chronic pain in this population.
Methods
This was a cross-sectional observational study with a convenience sample in the outpatient clinic at two research centers. All participants answered sociodemographic and clinical questionnaires, and the Pressure Pain Threshold (PPT) was assessed with an algometer. Patients reporting chronic pain answered the Geriatric Pain Measure (GPM) questionnaire.
Results
The sample consisted of 230 individuals, aged 60 to 96 years, 67.8% women and 32.2% men. Chronic pain prevalence was 47.8%, 29.7% in men and 56.4% in women. PPT was significantly lower in women (4.49 § 1.78 kg) than in men (6.41 § 1.92 kg). PPT in older individuals presenting chronic pain (4.58 § 1.93 kg) was lower than in older individuals without chronic pain (5.58 § 2.01 kg). There was no significant difference between genders in pain assessment by GPM.
Conclusions
Pressure pain threshold was lower in older women and in patients with chronic pain, the association between gender and lower pain threshold was stronger than observed with chronic pain.
Keywords
Resumo
Introdução
A população idosa está crescendo, e estima-se que, até 2050, o número de pessoas com 60 anos ou mais alcance dois bilhões. O aumento da expectativa de vida tem levado a uma maior incidência de doenças crônicas degenerativas, contribuindo para o aumento das queixas de dor. Este estudo tem como objetivo comparar o limiar de dor após estimulação mecânica em idosos segundo o gênero e a presença ou ausência de dor crônica, além de identificar a prevalência e intensidade da dor crônica nessa população.
Métodos
Estudo observacional transversal com amostra de conveniência realizado em ambulatórios de dois centros de pesquisa. Todos os participantes responderam questionários sociodemográficos e clínicos, e o Limiar de Dor à Pressão (PPT) foi avaliado por meio de algômetro. Pacientes que relataram dor crônica responderam ao questionário Escala de Dor Geriátrica (GPM).
Resultados
A amostra foi composta por 230 indivíduos com idades entre 60 e 96 anos, sendo 67,8% mulheres e 32,2% homens. A prevalência de dor crônica foi de 47,8%, 29,7% entre homens e 56,4% entre mulheres. O PPT foi significativamente menor nas mulheres (4,49 ± 1,78 kg) do que nos homens (6,41 ± 1,92 kg). O PPT nos idosos com dor crônica (4,58 ± 1,93 kg) foi menor do que nos idosos sem dor crônica (5,58 ± 2,01 kg). Não houve diferença significativa entre os gêneros na avaliação da dor pelo GPM.
Conclusão
O limiar de dor por pressão foi menor em mulheres idosas e em pacientes com dor crônica, sendo que a associação entre gênero e menor limiar de dor foi mais pronunciada do que aquela observada com a dor crônica.
Palavras-chave
References
1. World Health Organization (WHO). World Health Organization. [cited 2023 Jan 10]. Ageing and health. Available from: https://www.who.int/news-room/fact-sheets/detail/ageingand-health.
2. Celich KLS, Galon C. Dor cronica em idosos e sua in ^ fluencia nas ^ atividades da vida diaria e conviv encia social. Rev Bras Geriatr ^ Gerontol. 2009;12:345−59.
3. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Iii JLR. Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings. J Pain. 2009;10:447−85.
4. Dahlhamer JM, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults ‒ United States, 2016. Morb Mortal Wkly Rep. 2018;67:1001−6.
5. Mogil JS. Sex differences in pain and pain inhibition: multiple explanations of a controversial phenomenon. Nat Rev Neurosci. 2012;13:859−66.
6. Athnaiel O, Davidson N, Mangat J, Nasr NF, Knezevic NN. Gonadal Hormone Changes With Aging and Their Impact on Chronic Pain. Cells. 2025;14:123.
7. Palmeira CC, Ashmawi HA, Posso Ide P. Sex and pain perception and analgesia. Rev Bras Anestesiol. 2011;61:814−28.
8. Gibson CJ, Li Y, Bertenthal D, Huang AJ, Seal KH. Menopause symptoms and chronic pain in a national sample of midlife women veterans. Menopause. 2019;26:708−13.
9. Barbosa Neto JO, Garcia JBS, Cartagenes MDSDS, Amaral AG, Onuchic LF, Ashmawi HA. Influence of androgenic blockade with flutamide on pain behaviour and expression of the genes that encode the NaV1.7 and NaV1.8 voltage-dependent sodium channels in a rat model of postoperative pain. J Transl Med. 2019;17:287.
10. Aloisi AM, Ceccarelli I, Fiorenzani P, De Padova AM, Massafra C. Testosterone affects formalin-induced responses differently in male and female rats. Neurosci Lett. 2004;361:262−4.
11. Girotti G, Trevisan C, Fratta S, et al. The impact of aging on pressure pain thresholds: are men less sensitive than women also in older age? Eur Geriatr Med. 2019;10:769−76.
12. Petrini L, Matthiesen ST, Arendt-Nielsen L. The Effect of Age and Gender on Pressure Pain Thresholds and Suprathreshold Stimuli. Perception. 2015;44:587−96.
13. Lautenbacher S, Peters JH, Heesen M, Scheel J, Kunz M. Age changes in pain perception: A systematic-review and metaanalysis of age effects on pain and tolerance thresholds. Neurosci Biobehav Rev. 2017;75:104−13.
14. World Health Organization (WHO). ENVELHECIMENTO ATIVO: UMA POLITICA traduc¸ ao Suzana Gontijo. Brasília: Organiza ~ c¸ ao~ Pan-Americana da Saude; 2005 www.opas.org.br (26 August 2018, date last accessed).
15. Treede RD, Rief W, Barke A, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019;160:19−27.
16. Motta TS da, Gambaro RC, Santos FC. Pain measurement in the elderly: evaluation of psychometric properties of the Geriatric Pain Measure − Portuguese version. Rev Dor. 2015;16:136−41.
17. Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestoes para o uso do mini-exame do estado mental no Brasil. ~ Arq Neuropsiquiatr. 2003;61:777−81.
18. De Rui M, Marini I, Bartolucci ML, et al. Pressure pain threshold of the cervico-facial muscles in healthy elderly people: the role of gender, age and dominance. Gerodontology. 2015;32: 274−80.
19. Meints SM, Mawla I, Napadow V, et al. The relationship between catastrophizing and altered pain sensitivity in patients with chronic low-back pain. Pain. 2019;160:833−43.
20. Failla MD, Beach PA, Atalla S, et al. Gender Differences in Pain Threshold, Unpleasantness, and Descending Pain Modulatory Activation Across the Adult Life Span: A Cross Sectional Study. J Pain. 2024;25:1059−69.
21. Larsson C, Hansson EE, Sundquist K, Jakobsson U. Chronic pain in older adults: prevalence, incidence, and risk factors. Scand J Rheumatol. 2017;46:317−25.
22. Pereira LV, Vasconcelos PP, Souza LAF, et al. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study. Rev Lat Am Enfermagem. 2014;22:662−9.
23. Cheung CW, Choi SW, Wong SSC, Lee Y, Irwin MG. Changes in Prevalence, Outcomes, and Help-seeking Behavior of Chronic Pain in an Aging Population Over the Last Decade. Pain Pract. 2017;17:643−54.
24. den Bandt HL, Paulis WD, Beckwee D, Ickmans K, Nijs J, Voogt L. Pain Mechanisms in Low Back Pain: A Systematic Review with Meta-analysis of Mechanical Quantitative Sensory Testing Outcomes in People with Nonspecific Low Back Pain. J Orthop Sport Phys Ther. 2019;49:698−715.
Submitted date:
11/13/2024
Accepted date:
06/08/2025
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