Where Does it Hurt? A 4-S Model of Pain Onset and Recovery across Body Sites among Older Adults.

Objectives: Pain is an increasingly widespread problem for older adults, contributing to higher healthcare costs and lower quality of life. Though the prevalence of pain is well-documented in national studies, less is known about where pain occurs in the body, and even less about the dynamic processes of onset and recovery. We examine the bodily distribution of pain and its covariates and propose a framework to systematize how pain sites remain stable, spread, switch, or subside over time.

Methods: Analyses use longitudinal data from the National Social Life, Health, and Aging Project (n=2,600), a survey featuring pain site measures usually available only in clinical samples. Descriptive statistics and supplementary regression models showcase pain dynamics across bodily locations and over time.

Results: Pain is most prevalent in legs and low back. During the observed period, 57% of respondents had at least one onset location and 79% experienced at least one recovery location. Many displayed complex patterns of onset and recovery in tandem. Gender, exposure to childhood trauma, and perceived neighborhood danger emerged as key correlates of pain prevalence across bodily locations and pain dynamics over time, shaping whether pain remained stable, spread, switched locations, or subsided.

Discussion: Older Americans with pain rarely have their discomfort confined to one location, and many experience concurrent onset and recovery over time. We propose the 4-S model as a framework to understand the complex interplay of pain onset and recovery and offer ways to integrate this framework into ongoing investigations of late-life pain.