The relationship between lifecourse traumatic events and pain in an older rural South African population: A cross-sectional study

Pain in older adults is an increasing concern in low- and middle-income countries (LMICs), with literature suggesting an association with past traumatic events (TEs) in high-income settings. We aim to investigate this relationship in a population-representative sample of older adults with high burden of TEs in a rural South African community. The Health and Aging in Africa: A longitudinal Study of an INDEPTH Community in South Africa (HAALSI) study collected data pain intensity, using the Brief Pain Inventory, and TEs with a 16-item questionnaire, from 2411 participants aged 40-79 in 2014-15. We used logistic regression models to test the association between TE exposure and self-reported pain status. TE experience was near-universal (99.1% experience of at least one), while 9.0% of participants reported current pain, of which 86.6% was moderate/severe. In multivariable regression, increased odds of moderate/severe pain was associated with more TEs of any kind (OR 1.08; 95%CI 1.02-1.15 per additional TE) and with past exposure to disasters, accidents and illnesses (men and women), violence in the community (women only) and social/family environment problems (men only)-but not with childhood or war-related TEs. TEs were associated with pain even within a rural resource-limited setting where trauma experiences were extremely common. However, associations varied by TE type and sex. Interventions to prevent pain in older adults need to be targeted to block specific mechanisms that vary within even at-risk populations.