Frailty-informed pain management: a clinical imperative beyond chronological age

Abstract

[Abstract] Background: Chronic pain is a prevalent and disabling condition whose management becomes increasingly complex with aging and frailty. While chronological age often guides clinical decisions, frailty offers a more biologically grounded approach.

Aims: We sought to examine the independent associations of chronological age, frailty, and sex with pain management variables in a community-based adult population.

Methods: A cross-sectional study was conducted in 455 adults with chronic non-cancer pain. Frailty was assessed using a 31-item frailty index (FI) on the basis of the deficit accumulation model. A total of 169 pain-related variables were collected. Multivariable regression models were used to explore associations between age, FI, sex, and pain management outcomes.

Results: Frailty was independently associated with nonsteroidal anti-inflammatory drug (NSAID) self-medication (odds ratio [OR] 1.03, 95% confidence interval [CI]: 1.01-1.04), greater use of nonpharmacological interventions (sr = 0.13), consumption of multiple analgesic classes (including paracetamol, opioids, and adjuvants), and absence of baseline pain control (OR 0.96, 95% CI 0.93-0.98). In contrast, older age was the main negative predictor of NSAID and anxiolytic prescriptions and physiotherapy use. Notably, frailty and age showed opposite associations for several outcomes, including number of prescribed analgesics and healthcare utilization.

Conclusions: Frailty, as a proxy for biological age, was more strongly associated with pain management patterns than chronological age. Sole reliance on age may lead to undertreatment and ageist biases. These findings should, however, be interpreted with caution given the cross-sectional observational design, which precludes causal inference. Incorporating frailty into pain care strategies may nonetheless support more personalized, effective, and safer management across the adult