Falls are a major cause of serious injury and death in elderly adults. While a number of risk factors have been well characterized, the effectiveness of fall prevention strategies remain disappointing. One explanation for this limited success might be that important causes of falls have yet to be identified or fully understood. Leveille and colleagues analyzed data from the longitudinal MOBILIZE (Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly) Boston Study to determine whether chronic musculoskeletal pain—a major contributor to disability in elderly people—contributes to the risk of falls.

The study included 749 community-living adults aged ≥70 years. Chronic pain was assessed in terms of its location, severity and degree of intereference with daily activities. A 13-item joint pain questionnaire was used to identify musculoskeletal pain in the hands, wrists, shoulders, back, chest, hips, knees and feet; based on this measure, participants were categorized as having no pain (n = 267), pain at a single site (n = 181), or polyarticular pain (pain at two or more sites; n = 300). Severity and interference were measured using relevant subscales of the Brief Pain Inventory.

In total, 1,029 falls occurred in 405 (55%) of the participants during 18 months of follow-up. After adjusting for multiple confounders and risk factors for falls, including age, sex, comorbid diseases and medication use, the rate ratio of falls per person-year was highest for participants with polyarticular pain (1.53, 95% CI 1.17–1.99) compared to those with no pain, and for participants in the highest tertiles of pain severity (1.53, 95% CI 1.12–2.08) or pain interference (1.53, 95% CI 1.15–2.05) at baseline compared to participants in the lowest tertiles.

The authors conclude that chronic musculoskeletal pain is an independent and potentially important risk factor for falls in the elderly, and that pain-reducing interventions might reduce the risk of falls in this population.