Low Back Pain In Older Adults Research Articles

Paralumbar Spine Disease as a Cause of Low Back Pain in Older Adults.

Introduction Low back pain (LBP) is a major contributor to decreases in the ability to perform activities of daily living (ADL) in older adults. Paralumbar spine disease (PLSD) is a common cause of LBP. We aimed to investigate the causes of LBP, including PLSD, among older adults. Methods Among 744 consecutive patients with LBP, 75 patients (10.1%) aged >80 years (25 males and 50 females) were included. The average patient age was 83.9 years. All patients were evaluated using lumbar magnetic resonance imaging (MRI) and radiography to diagnose the causes of LBP. PLSD was diagnosed based on clinical symptoms, palpation, and the effects of the block. Results Eleven patients (11/75, 14.7%) had acute osteoporotic vertebral fractures. Twenty-eight of the remaining 64 patients exhibited decreased LBP with oral medication, and six (6/75, 8.0%) exhibited lumbar spinal canal stenosis on MRI. PLSD was suspected in 19 of the remaining 30 cases based on clinical symptoms and palpation. Blocks were effective in 16 patients with PLSD, which involved superior cluneal nerve entrapment (SCN-E) in eight patients (10.7%), middle cluneal nerve entrapment (MCN-E) in nine patients (12.0%), sacroiliac joint (SIJ) pain in five patients (6.7%), and gluteus medius muscle (GMeM) pain in three patients (4.0%). The average numerical rating scale (NRS) scores for pain changed from 7.5 ± 1.5 before treatment to 1.3 ± 0.9 at discharge (p < 0.05). Conclusion Osteoporotic acute vertebral fracture (14.7%) was identified as the cause of LBP in older adults. Block therapy for PLSD may aid in the diagnosis and treatment of non-specific LBP.

Examining Psychological Factors as Contributors to Pain, Disability, and Physical Function in Geriatric Chronic Low Back Pain: A Prospective Analysis of the Delaware Spine Studies Cohort

In younger populations, risk factors from psychologically-focused theoretical models have become accepted as primary drivers behind the persistence of low back pain (LBP), but these risk factors have not been thoroughly assessed in older adult populations (60–85 years). To address this knowledge gap, we sought to examine longitudinal associations between both general and pain-related psychological risk factors and future pain intensity, LBP-related disability, and physical function (gait speed) outcomes in older adults with chronic LBP (n = 250). Questionnaires for general (ie, depressive symptoms) and pain-related psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were collected at baseline. Questionnaire values were entered into principal component analysis to yield a combined psychological component score. LBP intensity (pain thermometers), LBP-related disability (Quebec Back Pain Disability Scale), and gait speed were measured at baseline and 12-month follow-up. Multiple linear regression was used to examine adjusted associations between baseline psychological component scores and each prospective outcome. The baseline psychological component score failed to independently predict 12-month LBP-related disability and gait speed after adjustment for baseline outcomes. Though the psychological component score was associated with 12-month LBP intensity after adjusting for baseline LBP intensity, this association diminished with full adjustment for other baseline characteristics. Cumulatively, general and pain-related psychological risk factors did not independently predict longitudinal pain, disability, and physical function outcomes in this cohort. Compared to younger populations with this condition, general and pain-related psychological risk factors may have less influence on the maintenance of chronic LBP in older adults. PerspectiveThis article failed to establish consistent independent relationships between psychological factors and worse longitudinal pain, disability, and physical function outcomes in older adults with chronic LBP. The findings highlight a need to determine other age-specific biopsychosocial risk factors that may impact the maintenance of chronic pain in this patient population.

The impact of low back pain and vigorous activity on mental and physical health outcomes in older adults with arthritis.

BackgroundNearly 50% of Americans aged 65 and above have been diagnosed with arthritis and an estimated 80% of adults experience low back pain (LBP). Little is known about the experience of LBP in older adults with arthritis and its relationships with mental and physical health.ObjectiveIn this study, we examined the relationships between LBP and four physical and mental health conditions (psychological distress, insomnia, mobility limitations, and self-rated health) in older adults with arthritis in the National Health and Aging Trends Study (NHATS). We also examined whether vigorous exercise mediated the relationships between LBP and these four conditions.Materials and MethodsThe data from this study comes from waves five through nine of the NHATS. The sample size ranged from 3,490 to 2,026 across these waves. All variables in this study are based on self-report. We used descriptive analyses including means and standard deviations for continuous variables or frequencies and proportions for demographic data. We used structural equation modeling (SEM) to examine if vigorous activity mediated the relationship between LBP with the four conditions.ResultsThe age range of the sample was 65 years of age and older. Among those with back pain 78.53% had no mobility limitations. There was a significant relationship between LBP with insomnia (B = 0.48, p < 0.001), perceived health status (B = −0.38, p < 0.0010), and psychological distress (0.67, p < 0.001). Activity mediated the relationship between LBP and insomnia, psychological distress and physical health in adjusted models.DiscussionThe presence of low back pain in older adults with arthritis increases the risk of insomnia, psychological distress, mobility limitations, and poorer self-rated health. Consequently, targeting comorbid LBP may be an important component of the treatment plans of older adults with arthritis. In addition, providers of patients with arthritis and LBP should conduct routine assessments of mental and physical health to ensure the LBP is being adequately addressed.

The Impact of Low Back Pain and Physical Activity on Mental and Physical Health Outcomes in Older Adults With Arthritis

Abstract Nearly 50% of Americans aged 65 and above have been diagnosed with arthritis at any point in time, and an estimated 80% of adults experience low back pain (LBP) at some point in their lives. However, little is known about the experience of LBP in older adults with arthritis and whether or not it is related to adverse mental and physical health outcomes over and above those linked to arthritis. This study examined the relationship between LBP and four associated physical and mental health conditions (depression, insomnia, mobility limitations, and self-rated health) in older adults with arthritis. We also examined whether physical activity mediated the relationships between LBP and these four conditions. A cross-sectional analysis was conducted using data from the National Health and Aging Trends Study. Descriptive analyses and chi-square tests assessed whether there were demographic differences between persons with and without LBP. Binary logistic regressions found that participants with LBP were 30% more likely to endorse insomnia (95% confidence interval (CI) =1.1 to 1.5, p&amp;lt;.001), had 40% higher odds of depression (95% CI=1.1 to 1.6, p&amp;lt;.001), and 70% higher odds of poor self-rated health (95% CI=1.5 to 1.9, p&amp;lt;.001) than those without LBP. Activity mediated the relationship between LBP and the four health outcomes in unadjusted models. Findings indicate that LBP may be associated with adverse mental and physical health in older adults with arthritis, and treatment for older adults with arthritis and comorbid LBP should include interventions targeting LBP and routine assessment of mental and physical health.

The Effect of Lumbar Erector Spinae Muscle Endurance Exercise on Perceived Low-back Pain in Older Adults

This study investigates changes in lumbar erector spinae (LES) muscle endurance, perceived low-back pain (LBP), and perceived exercise fatigue in older adults, and analyzes the trends of these changes during a 5-week lumbar exercise. Sixteen older adults with LBP were equally and randomly divided into two groups: the experimental group with incline-standing and the control group with the level-standing positions. They were separately treated with lumbar exercise tasks and 10 seconds of muscle endurance tests using surface electromyography (sEMG). There was a trend of changes in both groups. The exercise tasks led to increase LES muscle endurance in the experimental group (53.7%) and the control group (45.4%) and decrease perceived LBP score significantly with the incline-standing position. There was no significant difference between the two groups in perceived exercise fatigue (p&gt;0.05). Trunk flexion and extension with an incline-standing position can be an effective method to increase LES muscle endurance and reduce LBP in older adults.

Association of objectively measured physical activity with combined bilateral knee and low-back pain in older adults with knee osteoarthritis: A cross-sectional study.

Knee pain (KP) and low-back pain (LBP) are common sites of pain and major public health issues among older adults. We investigated the combined association of bilateral KP and LBP with objectively measured physical activity (PA) among adults with knee osteoarthritis (OA). We recruited 150 knee OA adults and measured steps and PA intensity, including sedentary behavior (SB), low PA (LPA), and moderate-to-vigorous PA, using an accelerometer. KP and LBP were measured using a numerical rating scale. They were classified into 4 groups based on the presence of KP and LBP: with the only unilateral KP (UKP), with the combined UKP and LBP (UKP and LBP), with the bilateral KP (BKP), and with the combined bilateral KP and LBP (BKP and LBP). One-way analysis of covariance was performed to compare physical activity variables (intensity or steps) between the four groups. Overall, 126 patients were enrolled. The prevalence of UKP, BKP, UKP and LBP, and BKP and LBP were 29.4%, 23.8%, 18.3%, and 28.6%. The proportion of SB was higher in the BKP and LBP group than in the other groups (F = 6.51, p < 0.01). The proportion of LPA was lower in the BKP and LBP group than in the other groups (F = 6.21, p < 0.01). The proportions of SB and LPA were significantly worse in knee OA adults with BKP and LBP than in those with UKP. Our findings may be a basis for considering knee OA adults for improving PA.

Influence of the number and severity of comorbidities in the course of acute non-specific low back pain in older adults: longitudinal results from the Back Complaints in the Elders (BACE-Brazil).

The presence of comorbidities is quite common in older adults. However, the effects of comorbidities on the course of acute low back pain (LBP) are not fully understood. To investigate the effects of the number and severity of comorbidities on the severity of pain and disability 3months from baseline in people with an acute episode of non-specific LBP. Data from the Back Complaints in the Elders study, a cohort that enrolled 602 community-dwelling older adults with acute LBP at baseline, were used in these analyses. Comorbidities, pain intensity and disability were assessed using the Self-Administered Comorbidities Questionnaire (SCQ), the Numeric Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ), respectively. Age, sex, marital status, education, income and body mass index were covariates. The mean age of participants was 67.6 ± 7.0years. Both pain and disability scores decreased from 7.2 (95% confidence interval [95% CI] 7.0-7.4) to 5.8 (95% CI 5.5-6.1) in NRS and from 13.5 (95% CI 13.0-14.1) to 12.0 (95% CI 11.4-12.7) in RMDQ 3months from baseline. The linear regression analysis showed a significant association between SCQ scores at baseline and pain (coefficient = 0.16, 95% CI 0.08-0.24; P < 0.001) or disability (coefficient = 0.29, 95% CI 0.16-0.41; P < 0.001) scores at the 3-month follow-up, after adjusting for confounders. Participants with highest SCQ scores were less likely to report improvement of at least 30% in pain (OR: 0.41, 95% CI 0.22-0.79; P = 0.008) and disability (OR: 0.42, 95% CI 0.28-0.85; P = 0.015). The presence and severity of comorbidities were independently associated with the prognosis of acute non-specific LBP in older adults.

Discussions on real-world acupuncture treatments for chronic low-back pain in older adults

Chronic low-back pain (CLBP) is one of the most common pain conditions. Current clinical guidelines for low-back pain recommend acupuncture for CLBP. However, there are very few high-quality acupuncture studies on CLBP in older adults. Clinical acupuncture experts in the American Traditional Chinese Medicine Association (ATCMA) were interested in the recent grant on CLBP research announced by the National Center for Complementary and Integrative Health. The ATCMA experts held an online discussion on the subject of real-world acupuncture treatments for CLBP in older adults. Seven participants, each with more than 20 years of acupuncture practice, discussed their own unique clinical experience while another participant talked about the potential mechanism of acupuncture in pain management. As a result of the discussion, a picture of a similar treatment strategy emerged across the participants for CLBP in older adults. This discussion shows that acupuncture may have complicated mechanisms in pain management, yet it is effective for the treatment of chronic pain involving maladaptive neuroplasticity; therefore, it should be effective for CLBP in older adults.

Paradigm Shift in Geriatric Low Back Pain Management: Integrating Influences, Experiences, and Consequences.

Geriatric low back pain (LBP) can have a profound impact on physical activity and can cause a decline in physical function, which is a major health risk for older adults. Within the last decade, physical therapist management of LBP has shifted from an emphasis on pathoanatomical mechanisms, such as spine degeneration, to addressing psychological distress factors. Although this approach is promising, the complexity of LBP in older adults (including biological, psychological, cognitive, and social influences), which may differ from that in younger adults, must be considered. Further, outcome assessment should represent not only the LBP experience (eg, pain intensity, pain with movement) but also LBP consequences, such as physical activity decline and physical function decline. This perspective discusses influences on geriatric LBP, experiences, and consequences with the goal of facilitating standardized and comprehensive physical therapist management.

A longitudinal study of the influence of comorbidities and lifestyle factors on low back pain in older men.

Older adults are largely under-represented in low back pain (LBP) research. In light of the ageing population, it is crucial to understand the influence of comorbidities and lifestyle factors on the risk and prognosis of LBP in older adults. The aims of this study were to describe the course of LBP in older men; to investigate whether comorbidities/lifestyle factors can predict the course of LBP in older men; to assess if comorbidities/lifestyle factors increase the risk of developing LBP in older men. The study sample comprised 1685 older men living in suburban Sydney, Australia. Low back pain, sociodemographic measures, lifestyle factors, and comorbidities were assessed. Of the 1012 men with LBP at baseline, 58% still reported having pain at the 24-month follow-up. Of those without pain at baseline (n = 673), 28% reported pain at follow-up. The odds of persistent pain at 24 months increased with each additional alcoholic drink/wk (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.01-1.22; P = 0.03) and each additional unit of body mass index (OR = 1.28, 95% CI: 1.04-1.60; P = 0.02), but reduced for men who speak English at home (OR = 0.58, 95% CI: 0.35-0.96; P = 0.03). In older men, free of LBP at baseline (n = 673), for every additional comorbidity there was an increased risk of developing LBP (OR = 1.17, 95% CI: 1.00-1.37; P = 0.05). These results demonstrate the influence of lifestyle factors and comorbidities on LBP in older men and suggest that the consideration of these issues in management may improve outcomes.