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Impact of Community-Based Chronic Pain Assessment on Chronic Pain Detection among Older Adults in Nigeria

Abstract

Chronic pain is an important health concern among older adults in Nigeria and may result from conditions such as osteoarthritis, chronic back pain, neuropathic disorders, previous injuries, and other age-related or long-term health conditions. Persistent pain may negatively affect mobility, sleep, psychological well-being, social participation, independence, and overall quality of life. However, chronic pain may remain undetected or inadequately managed because older adults may consider persistent pain a normal part of ageing, while limited access to healthcare, financial constraints, geographical barriers, low awareness, and inadequate pain assessment services may further contribute to underrecognition. Community-based chronic pain assessment provides an opportunity to identify older adults experiencing persistent pain through community outreach programmes, primary healthcare centres, home-based care services, senior citizen groups, and other accessible community platforms. Early detection can facilitate clinical evaluation, appropriate pain management, physiotherapy, rehabilitation, medication review, self-management education, and referral to appropriate healthcare professionals. Against this background, this study investigates the impact of community-based chronic pain assessment on chronic pain detection among older adults in Nigeria. The study will be anchored on the Health Belief Model, Biopsychosocial Model of Pain, and Social Ecological Model. The Health Belief Model explains how older adults' perceptions of susceptibility to chronic pain, perceived severity, perceived benefits of pain assessment, perceived barriers, and cues to action may influence participation in community-based pain assessment and healthcare-seeking behaviour. The Biopsychosocial Model of Pain recognizes the interaction of biological, psychological, and social factors in the experience, reporting, and management of chronic pain. The Social Ecological Model emphasizes the influence of individual, family, community, socioeconomic, environmental, and healthcare-system factors on pain experience, healthcare access, and pain management among older adults. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based chronic pain assessment may influence chronic pain detection among older adults in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adults aged 60 years and above residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, primary healthcare centres, senior citizen groups, and eligible older adults. Community-based chronic pain assessment will be measured using indicators such as availability of pain assessment services, assessment coverage, frequency of assessment activities, use of validated pain assessment instruments, pain intensity assessment, pain duration assessment, assessment of pain location and characteristics, evaluation of functional limitations, mobility assessment, sleep-related effects, psychological effects, medication use, availability of trained healthcare personnel, pain education, and referral arrangements. Chronic pain detection will be assessed using indicators such as identification of pain persisting for three months or longer, newly identified chronic musculoskeletal pain, chronic back pain, osteoarthritic pain, neuropathic pain symptoms, pain-related functional limitations, older adults requiring further clinical evaluation, newly detected chronic pain, referrals for pain management or specialist assessment, and documented clinical diagnoses where appropriately established. Data will be collected using structured questionnaires, validated pain assessment instruments, community health assessment forms, healthcare records where available, medication records, and referral registers. Descriptive statistics will be used to summarize participants' demographic characteristics, pain patterns, assessment coverage, pain severity, functional limitations, and chronic pain detection rates. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the impact of community-based chronic pain assessment on chronic pain detection. Where appropriate, chronic pain detection rates before and after implementation of community-based pain assessment activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based chronic pain assessment has a significant positive impact on chronic pain detection among older adults in Nigeria. Older adults who participate in systematic community-based pain assessment are expected to have a higher likelihood of previously unrecognized chronic pain being identified than those without access to such assessment. Routine assessment may facilitate early recognition of persistent musculoskeletal pain, chronic back pain, osteoarthritic pain, neuropathic symptoms, pain-related functional limitations, and other chronic pain conditions. Early detection may provide opportunities for appropriate clinical evaluation, pain-management education, physiotherapy, rehabilitation, medication review, lifestyle modification, and referral to relevant healthcare professionals. Bringing pain assessment services closer to older adults may reduce geographical, financial, mobility, and transportation barriers and may reach individuals who rarely seek healthcare for persistent pain. Community-based health education may also improve awareness that persistent pain should not necessarily be regarded as an unavoidable part of ageing and may encourage older adults to seek appropriate assessment. Conversely, limited availability of trained healthcare personnel, inadequate pain assessment tools, financial constraints, mobility difficulties, low awareness, cultural beliefs, and weak referral and follow-up systems may reduce the effectiveness of community-based chronic pain assessment. The study therefore expects accessible and systematically implemented community-based chronic pain assessment to contribute significantly to improved detection and early management of chronic pain among older adults in Nigeria. The study is expected to contribute to the literature on community-based chronic pain assessment, chronic pain detection, older adults' health, geriatric health, musculoskeletal health, pain management, functional health, healthy ageing, community health services, preventive healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, geriatric services, physiotherapists, nurses, community health workers, pain-management practitioners, older adults' organizations, development partners, and policymakers regarding strategies for improving chronic pain identification and management. The study will also provide evidence-based recommendations for expanding community-based chronic pain assessment, strengthening pain assessment capacity at the primary healthcare level, increasing availability of trained healthcare personnel, improving access to pain-management and rehabilitation services, strengthening referral and follow-up systems, promoting healthy ageing and pain-management education, and integrating routine chronic pain assessment into appropriate community-based primary healthcare programmes across Nigeria.

Keywords: Community-based chronic pain assessment, chronic pain detection, older adults, geriatric health, chronic pain, musculoskeletal health, pain assessment, pain management, healthy ageing, community health services, Nigeria, public health.