The prevalence of musculoskeletal pain is known

to increase with age until it stabilises around age 65 [17]. However, the prevalence of disabling pain that impacts on life increases notably among older people into the oldest age-groups [18]. The impact on individuals can be significant [3]. A review of chronic pain prevalence in older people found estimates ranging from 18-57% [19]. The wide range was partly explained by the variation in definitions used for chronic pain [19]. There is less precise information about the prevalence, impact or treatment of musculoskeletal Inhibitors,research,lifescience,medical pain at the end of life. Consequently it is possible that a major cause of pain is being overlooked and a potential target for improving quality of life is being ignored. The objective of this study was to conduct a systematic search of the literature with the aim of highlighting what is currently known about musculoskeletal pain in older adults at the end of life and the identification Inhibitors,research,lifescience,medical of priorities for future research. Methods Search strategy A modified PICO search [18]

was used to identify information regarding musculoskeletal pain at the end of life. No comparison group was included as a scoping search had shown that there was limited literature available Inhibitors,research,lifescience,medical and we therefore planned to keep the search parameters as broad as possible. The key words used to define the population were ‘palliative’, ‘end of life’, ‘death and dying’, ‘terminal care’ or ‘terminally ill’. Inhibitors,research,lifescience,medical ‘Musculoskeletal’, ‘arthritis’, ‘osteoarthritis’ or ‘rheumatoid’ were used to define the NVP-LDE225 in vivo exposure whilst ‘pain’, ‘arthralgia’ or ‘polyarthralgia’ were used to define outcome. The databases searched were Amed, Cinahl, Internurse, Medline, PsychInfo,and Web of Knowledge (from inception to September 2012). (See Table 1 for further details). Inhibitors,research,lifescience,medical As Internurse had a more limited search function it was searched separately. The Cochrane database was searched but no relevant review was found. The grey literature was

searched using http://www.opengrey.eu. The reference lists of all relevant research papers found were searched for further citations. Independent advice about the search strategy was obtained from an information specialist. Table 1 Search process Study selection Inclusion criteria were that papers must be written in English and report original research that considered adults aged 50 or older. There is no general agreement about when old age begins [20]. This search used Thiamine-diphosphate kinase the broad definition of 50+ as used by the World Health Organisation [20], both to maximise the potential literature found and to acknowledge that socially constructed concepts of age often include biological as well as chronological factors. (However, no papers were found which had to be excluded because they only focused on younger adults). Papers that highlighted pain as a diagnostic feature of disease with the aim of delaying or preventing death were excluded.