Concurrent Validity of the Operationalization of High-Impact Pain Construct in the Health and Retirement Study

Purpose: Chronic pain epidemiology is hindered by inconsistent definitions and methods. The U.S. National Pain Strategy introduced high-impact chronic pain as a pain surveillance standard, defined as chronic pain that interferes with daily life. This study aimed to validate the operationalization of high-impact pain in the Health and Retirement Study (HRS), a large, nationally representative cohort of older adults. Patients and methods: We analyzed data from the 2010 HRS pain module. High-impact pain was operationalized with two questions that have been fielded in the HRS nearly since its inception. Pain intensity and pain-related disability were assessed using numeric rating scales and the Pain Disability Index (PDI). We used Wilcoxon rank-sum tests and logistic regressions to compare high- versus low-impact pain. Pain impact was also assessed at a 2-year follow-up in 2012. Results: Out of 508 participants, 335 (65.9%) reported high-impact pain. Those with high-impact pain had significantly higher pain-related disability (median PDI: 48 [33, 60] vs. 19 [8, 36], P<0.0001), average pain intensity (median: 6 [4, 8] vs. 5 [3, 6], P<0.0001) and were more likely to report chronic (OR: 1.75 [95% CI: 0.19, 2.58]) and constant (OR: 3.09 [1.93, 4.93]) pain. High-impact pain was associated with a relative risk of 1.80 (1.53, 2.11) for continued high-impact pain at a 2-year follow-up. Conclusion: The HRS operationalization of high-impact pain demonstrates strong concurrent validity with established measures of pain disability, intensity, and impact. The HRS provides a valuable tool for advancing pain research, particularly in aging populations.