The clinical course of pain and function in older adults with a new primary care visit for back pain.

Abstract

To report the clinical course of older adults presenting for a new primary care visit for back pain, no healthcare visit for back pain within the prior 6 months, by describing pain intensity, disability, pain interference, and resolution of back pain over 12months. Prospective inception cohort study. Primary care settings of three integrated healthcare systems in the United States that participated in the Back pain Outcomes using Longitudinal Data (BOLD) registry. Five thousand two hundred eleven (99.5%) of the 5,239 adults aged 65 and older who had reached their 12-month follow-up date. Baseline demographic characteristics, EQ-5D score, duration of back pain, expectation for recovery, depression, and anxiety. Participant-reported outcomes of back-related disability (Roland Morris Disability Questionnaire), numerical pain rating scale, pain interference, and resolution of back pain were collected at baseline and 3, 6, and 12months. Most improvement occurred within the first 3months. The number and proportion with 30% improvement in back pain increased from 1,950 (42.3%) at 3months to 1,994 (44.8%) by 12months, and 1,331 (28.8%) and 1,576 (35.4%) had 30% improvement in disability at 3 and 12months. Only 23.0% reported that their back pain had resolved at 12months. Improvements in disability and interference with activity over 12months differed according to age, duration of back pain, symptoms of depression and anxiety, and expectation for recovery. The majority of older adults in primary care practice settings presenting with a new visit for back pain have persistent symptoms, disability, and interference over 12months of follow-up. Future research is needed to identify risk factors for persistent symptoms and effective interventions.