Clinical and radiographic features of spinal osteoarthritis predict long-term persistence and severity of back pain in older adults

AbstractObjectiveTo estimate the prevalence of co-occurring pain sites among older adults with persistent back pain and associations of multisite pain with longitudinal outcomes.DesignSecondary analysis of a cohort study.SettingThree integrated health systems in the United States.SubjectsEight hundred ninety-nine older adults with persistent back pain.MethodsParticipants reported pain in the following sites: stomach, arms/legs/joints, headaches, neck, pelvis/groin, and widespread pain. Over 18 months, we measured back-related disability (Roland Morris, scored 0–24), pain intensity (11-point numerical rating scale), health-related quality of life (EuroQol-5D [EQ-5D], utility from 0–1), and falls in the past three weeks. We used mixed-effects models to test the association of number and type of pain sites with each outcome.ResultsNearly all (N = 839, 93%) respondents reported at least one additional pain site. There were 216 (24%) with one additional site and 623 (69%) with multiple additional sites. The most prevalent comorbid pain site was the arms/legs/joints (N = 801, 89.1%). Adjusted mixed-effects models showed that for every additional pain site, RMDQ worsened by 0.65 points (95% confidence interval [CI] = 0.43 to 0.86), back pain intensity increased by 0.14 points (95% CI = 0.07 to 0.22), EQ-5D worsened by 0.012 points (95% CI = –0.018 to –0.006), and the odds of falling increased by 27% (odds ratio = 1.27, 95% CI = 1.12 to 1.43). Some specific pain sites (extremity pain, widespread pain, and pelvis/groin pain) were associated with greater long-term disability.ConclusionsMultisite pain is common among older adults with persistent back pain. Number of pain sites was associated with all outcomes; individual pain sites were less consistently associated with outcomes.

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Low back pain in older adults

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0073 ◽

2017 ◽

pp. 563-570

Author(s):

Kieran O’Sullivan ◽

Kjartan Vibe Fersum ◽

Wim Dankaerts ◽

Peter O’Sullivan

Keyword(s):

Older Adults ◽

Low Back Pain ◽

Back Pain ◽

Health Service ◽

Pain Control ◽

Functional Approach ◽

Low Back ◽

Specific Factors ◽

Systemic Pathology

Low back pain (LBP) is one of the most common reasons for enduring long-term disability and difficulty with activities of daily living. The assessment of LBP in older adults should first carefully rule out the rare possibility that the pain represents a serious spinal or systemic pathology. Thereafter, a clinical reasoning framework can be used to identify the specific mix of biopsychosocial factors which are most relevant in the pain presentation of each individual patient. A cognitive functional approach for each patient should then address those specific factors for each person, with a view to enhancing pain control, maintaining participation in valued activities, and reducing dependence on the health service.

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Self-perceived functional ability and performance-based testing of physical function in older women with or without long-term back pain – results of the H70 study

BMC Geriatrics ◽

10.1186/s12877-021-02177-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hilda Kristin Svensson ◽

Jon Karlsson ◽

Therese Rydberg Sterner ◽

Felicia Ahlner ◽

Ingmar Skoog ◽

...

Keyword(s):

Older Adults ◽

Back Pain ◽

Activities Of Daily Living ◽

Physical Function ◽

Older Women ◽

Birth Cohort ◽

Functional Ability ◽

Daily Living ◽

And Performance

Abstract Background The proportion of older adults is increasing rapidly, and the majority are female. In 2050, the number of persons aged 60 years and over is estimated to reach 2.1 billion worldwide, constituting one-third of the total population of Europe. Long-term back pain is a disabling and common condition, primarily affecting older women. Although standardized functional evaluations are essential in the screening of older adults, self-rated activities of daily living capture a different aspect of the person’s ability in the context of his or her environment and social support system. This study aimed to describe how older women with or without long-term back pain self-rate their activities of daily living (ADL) and instrumental activities of daily living (IADL) in relation to their performance-based testing of physical function, including walking test, leg muscle strength, balance, and endurance. Method This study is part of the Gothenburg H70 Birth Cohort Studies in Sweden (H70 studies) and uses data from the 1944 birth cohort examined in 2015–16 at age 70. In the present study, only female participants were included in the analysis, and all cases of dementia (n = 17) and cases of acute and sub-acute back pain excluded (n = 181), leaving an effective sample of 446 female participants. Results Women with long-term back pain self-perceived their ADL and IADL as being as good as those without back pain, although they performed poorer in all performance-based tests and perceived themselves as less physically fit. Conclusion The discrepancy between self-perceived functional ability (ADL/IADL) and performance-based testing of functioning based on clinical tests calls for further investigation to incentivize person-centered care in older women with long-term back pain in municipal or emergency health-care settings.

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