Association between the accumulation of unhealthy lifestyle factors and musculoskeletal pain in older adults.

BACKGROUND: Although previous studies have examined individual lifestyle behaviors in chronic musculoskeletal pain outcomes, the cumulative impact of unhealthy lifestyle behaviors remains unclear. OBJECTIVE: To assess whether the accumulation of unhealthy lifestyle behaviors, as measured by the LIFESTYLE-4 score, is associated with the intensity and distribution of musculoskeletal pain in older adults. METHODS: A cross-sectional study was conducted with 100 older adults with chronic pain (83% women; mean age 69 ± 9.8 years). Lifestyle-related factors were assessed using validated instruments: physical activity (International Physical Activity Questionnaire), diet (Mediterranean diet score), sleep (Pittsburgh Sleep Quality Index), and stress (Perceived Stress Scale-4). The LIFESTYLE-4 score was constructed by assigning one point for each unfavorable factor (Pittsburgh Sleep Quality Index score >5, Perceived Stress Scale-4 score > 8, physical activity <600 metabolic equivalent of task-min/wk, Mediterranean diet score <9). Pain intensity (numerical rating scale, 0-10) and pain distribution (regional vs. widespread) were the main outcomes. The data were analyzed using one-way analysis of variance, χ2 tests, and multivariate logistic regression adjusted for sociodemographic and clinical covariates. RESULTS: Analysis of variance showed significant differences in pain intensity between LIFESTYLE-4 score categories (F = 6.40, p = .004; ηp2 = 0.06). Participants with the highest score reported greater pain compared to the low (mean difference = 1.80, p = .010) and medium (mean difference = 1.49, p = .011) groups. Logistic regression showed higher odds of severe pain in the high-score group (odds ratio = 10.5, 95% confidence interval 1.08-102.3). A χ2 test revealed an association between LIFESTYLE-4 and the number of painful areas (χ2 (4) = 12.7, p = .013). CONCLUSION: The accumulation of multiple unhealthy lifestyle behaviors was associated with greater intensity and a wider distribution of musculoskeletal pain. These findings underscore the importance of multidomain lifestyle approaches in the prevention and treatment of pain among older adults.