Temporal association between chronic pain and frailty occurrence, and the modifiable role of a healthy lifestyle in Chinese middle-aged and older population: a community based, prospective cohort study.

Background: While western studies suggest a temporal association between chronic pain and frailty, as well as the impacts of healthy lifestyle interventions, these relationships remain underexplored in the Chinese population.

Methods: We conducted a longitudinal study with 13,601 participants from the China Health and Retirement Longitudinal Study, covering 2011-2018. Pain was assessed via self-report, and frailty was evaluated using a 29-item deficit-accumulation frailty index. Five lifestyle factors, such as physical activity, alcohol consumption, smoking, body mass index, and sleep duration, were assessed, and the participants were categorized into favorable, intermediate, and unfavorable lifestyle groups.

Results: During the 7-year follow-up, 3,356 cases of frailty were discerned. Participants who reported pain at baseline assessment had a higher risk of developing frailty compared to those without pain (hazard ratio [HR] = 1.10; 95%confidence interval [CI], 1.03-1.19). This association was particularly evident in middle-aged individuals (HR = 1.13; 95% CI, 1.01-1.26). Participants with severe pain at baseline assessment had a 1.16-fold higher risk of frailty (95%CI, 1.05-1.28, P= 0.0067). Among the participants with mild or moderate pain at baseline assessment, the risk of developing frailty was significantly reduced by a favorable lifestyle (HR = 0.62; 95% CI, 0.51-0.76) or intermediate lifestyle (HR = 0.83; 95% CI, 0.70-0.98). Additionally, a favorable lifestyle was significantly associated with a decreased risk of developing frailty in the participants with severe pain at baseline assessment (HR = 0.75; 95%CI, 0.59-0.96). Mediation analysis indicated that a healthy lifestyle could mitigate 2.97% of frailty risk associated with chronic pain.

Conclusions: Chronic pain is strongly associated with an increased risk of developing frailty in Chinese older population, but the implementation of healthy lifestyles can significantly reduce this risk.