Journal of the American Medical Directors Association · Feb 4, 2026

The Association of Pain With Physical Performance Among Community-Dwelling Older Adults in the PRO-EVA Study

By Mendes ADS, Gomes Fernandes Mâcedo SG, Sales WB et al.

OBJECTIVES: To examine which pain-related characteristics are most strongly associated with impairments in physical performance among community-dwelling older adults. DESIGN: Cross-sectional study with no intervention. SETTING AND PARTICIPANTS: A total of 694 adults aged 60 years or older, of both sexes, registered in Primary Health Care Units in Parnamirim, Brazil. METHODS: Chronic pain (lasting more than 3 months) was self-reported. Physical performance was assessed using the Short Physical Performance Battery (SPPB). Bivariate analyses were conducted using Student's t-tests and χ² tests. Multiple linear regression was applied to evaluate the association between pain-related variables and total SPPB scores, adjusting for covariates. RESULTS: Chronic pain prevalence was 56%. Pain exacerbation during walking was reported by 32%, and mean pain intensity was 5.7. The mean SPPB score was 9 (±2), and 31% of participants had low physical performance. Pain intensity and pain while walking were associated with worse physical performance; however, only pain intensity remained an independent predictor in adjusted models. Additional factors associated with lower performance included female sex, polypharmacy, lower engagement in walking activity, and lower Leganés Cognitive Test (LCT) scores. CONCLUSIONS AND IMPLICATIONS: Chronic pain, especially its intensity, is independently associated with reduced physical performance in older adults. These findings reinforce the need for primary care services to prioritize the identification and management of chronic pain to help preserve mobility and functional capacity in aging populations.

doi.org/10.1016/j.jamda.2025.106110PubMed 41580287Populations