Is chronic nonmalignant pain associated with decreased appetite in older adults? Preliminary evidence

OBJECTIVES: To examine the association between self-reported appetite impairment and pain intensity in community-dwelling older adults with chronic nonmalignant pain. DESIGN: Cross-sectional survey. SETTING: An outpatient pain clinic at the University of Pittsburgh. PARTICIPANTS: A convenience sample of 65 older adults with chronic nonmalignant pain. MEASUREMENTS: Demographics, pain intensity (short-form McGill Pain Questionnaire), self-reported appetite impairment using a newly developed instrument, mood (30-item Geriatric Depression Scale, (GDS)), cognitive status (Folstein Mini-Mental State Examination), dependence in feeding, dependence in grocery shopping and meal preparation, and comorbidities (Cumulative Illness Rating Scale). Medication information was classified as total number of medications, number of analgesics, number of opioids, and number of potential appetite-impairing side effects. RESULTS: Univariate analyses revealed that those who reported pain-related appetite impairment had higher pain intensity than those who reported no appetite impairment (P<.001). Comparison of subjects with and without pain-related appetite impairment revealed a significant difference in GDS scores (P=.027), number of analgesics (P=.015), and number of opioids (P=.014). None of the other variables was statistically significant. The relationship between pain intensity and perceived pain-related appetite impairment was maintained in an analysis of covariance that controlled for GDS score, number of analgesics, and presence of opioids (P=.004). CONCLUSION: Chronic pain is associated with self-reported appetite impairment in older adults, but examination of the influence of reduction in pain intensity on appetite improvement is needed to establish a causal relationship between chronic pain and diminished appetite.