The impact of chronic low back pain on older adults: A comparative study of patients and controls

Abstract

Chronic low back pain (CLBP) is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. Many older adults remain quite functional despite CLBP, and because age-related comorbidities often exist independently of pain (e.g., medical illnesses, sleep disturbance, mobility difficulty), the unique impact of CLBP is unknown. We conducted this research to identify the multidimensional factors that distinguish independent community dwelling older adults with CLBP from those that are pain-free. Three hundred twenty cognitively intact participants (162 with ≥ moderate pain for ≥ 3 months, and 158 pain-free) underwent comprehensive assessment of pain severity, medical comorbidity (illnesses, body mass index, medications), severity of degenerative disc and facet disease, lumbar flexion, psychological constructs (self-efficacy, mood, overall mental health), and self-reported as well as performance-based physical function. Significant differences were ascertained for all 22 measures. Discriminant function analysis revealed that eight measures uniquely maximized the separation between the two groups (self-reported function with the Functional Status Index and the SF-36, performance-based function with repetitive trunk rotation and functional reach, mood with the Geriatric Depression Scale, comorbidity with the Cumulative Illness Rating Scale and BMI, and severity of degenerative disc disease). These results should help to guide investigators that perform studies of CLBP in older adults and practitioners that want an easily adaptable battery for use in clinical settings.

Factors accounting for psychosocial functioning in patients with low back pain

“…None or weak relationships between sociodemographic characteristics and LBP-related disability were reported by other authors [43]. However, our findings and those from some other studies [36] suggest that older individuals might require more attention as they may be at a greater risk for developing subjective feelings of being disabled. On the other hand, higher educational status might be a protective factor diminishing the sense of LBPrelated disability.…”

“…Typically, the most evident consequences of the pain are limitations in mobility [15]. Many authors emphasize, however, that the effects of this disease cannot be confined only to motor dysfunctions since LBP exerts a profound negative impact also on the patients' psychological wellbeing [36].…”

Pain in older people with frailty

“…It has been proposed that persistent pain may contribute to, or accelerate the development of frailty in older people through mechanisms such as impaired mobility, depression, decreased nutritional intake and the burden of co-morbidities 9,10 , and interventions to improve pain management may help prevent frailty 11 .…”

Lumbar Mobility and Performance-Based Function: An Investigation in Older Adults with and without Chronic Low Back Pain

“…Chronic low back pain (CLBP) is more prevalent in older adults than young-to-middle aged adults, and occurrence among older adults has increased significantly over recent years [4,5]. Further, older adults with CLBP are more likely than those without pain to self-report functional limitations in activities of daily living (ADLs) [6,7].…”

“…For instance, transitioning from sit-to-stand, a common core component of many performance tests, requires sufficient lumbar mobility [13]. Although previous literature has shown that the presence [7,14] and severity [14,15] of CLBP are linked to poor performance, little is known regarding the role that clinically relevant, and potentially modifiable, factors (e.g., lumbar mobility) may have in the decline of performance.…”