Evidence of a gabapentinoid and diuretic prescribing cascade among older adults with lower back pain

Background: Lower back pain is one of the most common health-related complaints in the adult population. Thirty percent of Americans 65 years and older reported symptoms of lower back pain in 2004 (NCHS, 2006). Injection treatment is a commonly used non-surgical procedure to alleviate lower back pain in older adults. However, the effectiveness of injection treatment, particularly in older adults, has not been well documented. Objective: This study quantified the effectiveness of injection treatment on pain relief among adults 60 years and over who were diagnosed with degenerative lumbar spinal stenosis, a common cause of lower back pain in older adults. The variations of the effectiveness were examined by selected patient attributes. Study Design: Prospective, non-randomized, observational human study. Setting: Single institution spine clinic. Methods: Patients scheduled for lumbar injection treatment between January 1 and July 1, 2008 were prospectively selected from the study spine clinic. Selection criteria included patients age 60 and over, diagnosed with degenerative lumbar spinal stenosis and no previous lumbar injection within 6 months or lumbar surgery within 2 years. The pain sub-score of the SF-36 questionnaire was used to measure pain at baseline and at one and 3 months post injection. Variations in longitudinal changes in pain scores by patient characteristics were analyzed in both unadjusted (univariate) analyses using one-way analysis of variance (ANOVA), and adjusted (multiple regression) analyses using linear mixed effects models. Limitations: This study is limited by its sample size and observational design. Results: Of 62 patients receiving epidural steroid injections, the mean Pain score at baseline was 27.4 (SD =1 3.6), 41.7 (SD = 22.0) at one month and 35.8 (SD = 19.0) at 3 months. Mean Pain scores improved significantly from baseline to one month (14.1 points), and from baseline to 3 months (8.3 points). Post injection changes in pain scores varied by body mass index (BMI) and baseline emotional health. Based on a linear mixed effects model analysis, higher baseline emotional health, as measured by the SF-36 Mental Component Score (MCS≥50), was associated with greater reduction in pain over 3 months when compared to lower emotional health (MCS <50). In patients with higher emotional health, pain scores improved by 14.1 (P < .05: 95% CI 6.9, 21.3). Patients who were obese also showed significant improvement in pain scores over 3 months compared to non-obese patients. In obese patients, pain scores increased by 7.9 (P <.05; 95% CI:1.0, 14.8) points. Conclusion: Lower back pain in older adults with degenerative lumbar spinal stenosis might be clinically significantly alleviated after injection treatment. Pain relief varies by a patient’s personal and clinical characteristics. Healthier emotional status and obesity appears to be associated with more pain relief experienced over 3 months following injection. Key words: Degenerative lumbar spinal stenosis, low back pain, older adults, epidural steroid injection, MRI, SF-36, Pain sub-score.

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ANALYSIS OF FUNCTIONAL CAPACITY IN INDIVIDUALS WITH AND WITHOUT CHRONIC LOWER BACK PAIN

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172504156564 ◽

2017 ◽

Vol 25 (4) ◽

pp. 143-146 ◽

Cited By ~ 4

Author(s):

Claudiane Pedro Rodrigues ◽

Rubens Alexandre da Silva ◽

Elias Nasrala Neto ◽

Rodrigo Antonio Carvalho Andraus ◽

Marcos Tadeu Parron Fernandes ◽

...

Keyword(s):

Older Adults ◽

Back Pain ◽

Functional Status ◽

Lower Back Pain ◽

Functional Capacity ◽

Control Group ◽

Chronic Lower Back Pain ◽

Level Of Evidence ◽

Younger Adults ◽

Lower Back

ABSTRACT Objective: The objective of this study was to analyze the functional status of adult and older adult individuals with lower back pain . Methods: Eighty-three individuals were recruited, 42 older adults (20 with lower back pain and 22 control group) and 41 younger adults (21 with lower back pain and 20 control group). Functional capacity was assessed using the following tests: Timed Up and Go (TUG), Five Times Sit-to-Stand (FTSTS), six-minute walking test (SMWT), and sitting-rising test (SRT) . Results: In the younger adults, there was no difference in functional capacity between the groups (p>0.05). On the other hand, when statistical analysis was adjusted using body mass index (BMI) as a covariate, the lower back pain group performed more poorly on the SRT (p<0.004). Furthermore, poorer physical capacity was seen in the older adults with back pain via the SRT test (p=0.001), and when the BMI was adjusted, a statistical difference was seen in the SRT as well as the SMWT (p<0.05) . Conclusion: Older individuals with lower back pain have poorer physical performance, and the sitting-rising test is the most discerning for assessment of functional status in individuals with lower back pain. Level of Evidence III, Retrospective Comparative Study.

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Vitamin D Deficiency and Molecular Changes in Circulating MicroRNAs in Older Adults with Lower Back Pain

Pain Research and Management ◽

10.1155/2021/6662651 ◽

2021 ◽

Vol 2021 ◽

pp. 1-13

Author(s):

Hadeel A. Al-Rawaf ◽

Sami A. Gabr ◽

Ahmad H. Alghadir

Keyword(s):

Older Adults ◽

Vitamin D ◽

Back Pain ◽

Bone Metabolism ◽

Lower Back Pain ◽

Muscle Performance ◽

Circulating Mirnas ◽

Vitamin D Intake ◽

Lower Back ◽

Tnf Α

Background. MicroRNAs play an essential role in regulating pain processing within a wide range of clinical pain disorders. Objectives. The present study aimed to evaluate the role of circulating miRNAs as biomarkers of lower back pain in older adults. In addition, the correlation between miRNAs and other related cofounders such as muscle function, adiposity, malnutrition, and Ca and vitamin D intake was assessed. Methods. A total of 110 older subjects with an age range of 40–60 years were included in this study. The participants were classified according to a modified Oswestry lower back pain disability questionnaire (OSW) into subjects with minimal LBP (n = 40; LBP score: 0–20%), moderate LBP (n = 35; LBP score: 20–40%), and severe LBP (n = 35; LBP score: 41–60%). RT-PCR and immunoassays were used to study the circulating miRNA profile, vitamin D status, and CRP, IL-6, TNF-α, s-Ca, s-BAP, s-OC, and s-NTX levels. In addition, malnutrition and muscle performance were estimated in all subjects as other factors related to LBP. Results. In this study, normal LBP-OSW cutoff values (8.96 ± 3.6) were reported in 36.4% of the total population, whereas 63.6% of the population had higher LBP-OSW scores, classified as follows: 31.8% with moderate LBP (LBP-OSW score: 31.4 ± 9.1) and 31.8% with severe LBP (LBP-OSW score: 54.9 ± 14.6). Four circulating miRNAs, namely, miR-146a, miR-558, miR-155, and miR-124a, as biomarkers of the intensity of back pain were identified in all participants. In subjects with moderate to severe LBP, the expression levels of miR-146a and miR-558 were significantly reduced and those of miR-155 and miR-124a were significantly increased compared to subjects with minimal LBP scores. Subjects with moderate to severe LBP showed a significant increase in adiposity markers, lower PA, muscle performance, malnutrition, and lower Ca and vitamin D intake compared to normal controls. In addition, serum levels of vitamin D and circulated plasma markers of inflammation and bone metabolism such as CRP, IL-6, TNF-α, s-Ca, s-BAP, s-OC, and s-NTX were significantly reduced in severe LBP cases compared to those with minimal LBP scores. The expressed circulating miRNAs were significantly associated with the measured muscle performance, adiposity, PA score, inflammation, and bone metabolism cofounders in subjects with higher LBP-OSW scores. The expressed miRNAs, along with other LBP cofounders, were significantly associated with ∼63.9–86.4% of the incidence of LBP in older adults. Conclusions. In older adults with vitamin D deficiency, the severity of LBP was significantly associated with the expression of circulating miRNAs, adiposity, bone metabolism, inflammation, and muscle performance. In addition, the expressed miRNAs, along with other LBP cofounders, were significantly associated with ∼63.9–86.4% of the incidence of LBP in older adults. These results suggest the possibility of using microRNAs as therapeutics to alleviate established pain and as biomarkers in old adults with painful conditions.

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LOWER BACK PAIN AFFECTS MOBILITY-RELATED INJURIES IN OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.1071 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S291-S291

Author(s):

Tyler R Bell ◽

Pariya Fazeli ◽

Caitlin N Pope ◽

Michael Crowe ◽

Karlene Ball

Keyword(s):

Older Adults ◽

Back Pain ◽

Lower Back Pain ◽

Lower Limb ◽

Motor Vehicle ◽

Statistical Significance ◽

Longitudinal Impact ◽

Limb Function ◽

Lower Back ◽

Lower Limb Function

Abstract Pain causes functional limitations and might elevate risk for mobility-related injuries in older adults. For this reason, we examined the longitudinal impact of lower back pain on the likelihood of MVCs and falls. Between 1998 and 1999, participants (ages >55 years) completed cognitive and physical measures at three Motor Vehicle departments. Participants then completed a telephone interview (n=1,248) assessing yearly health complications and injuries, which continued annually for 14 years. Separate longitudinal models examined the relationship between lower back pain and MVC and fall likelihood while controlling for demographics and mobility. Overall, those with lower back pain were twice as likely to have a fall than unafflicted peers (95%CI:1.69-2.47) and odds of MVC was just beyond statistical significance (95%CI: 0.97-1.94). In persons with lower back pain, problems in lower-limb function, divided attention, and task-switching were associated with MVCs whereas problems in lower-limb function were related to falls. Addressing limitations from pain might reduce mobility-related injury in older adults.

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187. Injection Treatment Effectively Reduces Lower Back Pain Associated with Lumbar Spinal Stenosis in Older Adults

The Spine Journal ◽

10.1016/j.spinee.2009.08.228 ◽

2009 ◽

Vol 9 (10) ◽

pp. 98S

Author(s):

Virginia Briggs ◽

Patricia Franklin ◽

Thomas McLaughlin ◽

Wenjun Li ◽

David Lombardi ◽

...

Keyword(s):

Older Adults ◽

Back Pain ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lower Back Pain ◽

Lower Back ◽

Injection Treatment ◽

Lumbar Spinal

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Recent Pain Among Older Women and Men in the United States by Sexual Orientation

Innovation in Aging ◽

10.1093/geroni/igaa057.1700 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 527-527

Author(s):

Adena Galinsky ◽

Karen Fredriksen Goldsen ◽

James Dahlhamer ◽

Tina Norris

Keyword(s):

Older Adults ◽

Back Pain ◽

Sexual Orientation ◽

Lower Back Pain ◽

Bisexual Men ◽

Bisexual Women ◽

The Past ◽

Lower Back ◽

Straight Women ◽

And Bisexual

Abstract Pain is not only a result of other health problems but an independent condition that can negatively impact quality of life. Lesbian, gay, and bisexual older adults report more pain compared to their straight counterparts when pain is measured in the aggregate (e.g. “one or more of the following types of pain”). However, scant national research has examined if specific types of pain vary by sexual orientation among older adults. Using 2015-2018 National Health Interview Survey (NHIS) data, we used logistic regression to separately model four types of pain among women 50+ and men 50+ (lesbian/gay women: n=377, bisexual women: n=142, straight women: n=33,216; gay men: n=508, bisexual men: n=115, straight men: n=25,998) as functions of sexual orientation, controlling for age, race, education, and income. Lesbian women and bisexual men were more likely (AOR=1.46, 95% CI:1.03, 2.08; AOR=2.95, 95% CI:1.08, 3.79, respectively), but bisexual women were less likely (AOR=0.6, 95% CI:0.33, 1.05), than their straight counterparts to have had a migraine or severe headache in the past three months. Bisexual men were also more likely than straight men to report lower back pain in the past three months (AOR=1.66, 95% CI: 1.02, 2.72). Sexual minority women were more likely than straight women to report joint pain in the past 30 days and lower back pain in the past three months. Future research may examine why the prevalence of specific types of pain vary by sexual orientation among older adults.

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