Highlights
- •It is unclear which aspects of pain drive poor health outcomes in geriatric chronic low back pain
- •Movement-evoked pain was associated with worse perceived disability and self-efficacy at 12-months
- •Resting/recall pain, as well as widespread pain, were not associated with future health outcomes
ABSTRACT
It is currently unknown which pain-related factors contribute to long-term disability
and poorer perceived health among older adults with chronic low back pain (LBP). This
investigation sought to examine the unique influence of movement-evoked pain (MeP)
and widespread pain (WP) on longitudinal health outcomes (i.e., gait speed, perceived
disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited
with three standardized functional tests, while presence of WP was derived from the
McGill Pain Map. Robust regression with HC3 standard errors was used to examine associations
between these baseline pain variables and health outcomes at 12-month follow-up. Covariates
for these models included age, sex, body mass index, resting and recall LBP intensity,
LBP duration, depression, pain catastrophizing, and baseline outcome (e.g., baseline
gait speed). Greater MeP was independently associated with worse 12-month LBP-related
disability (b=0.384, t=2.013, p=0.046) and poorer self-efficacy (b=-0.562, t=-2.074,
p=0.039); but not gait speed (p>0.05). In contrast, WP and resting and recall LBP
intensity were not associated with any prospective health outcome after adjustment
(all p>0.05). Compared to WP and resting and recall LBP intensity, MeP is most strongly
related to longitudinal health outcomes in older adults with chronic LBP.
Perspective: This article establishes novel independent associations between MeP and worse perceived
disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely
has biopsychosocial underpinnings and consequences and may therefore be an important
determinant of health outcomes in LBP and other geriatric chronic pain populations.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Cortical alpha rhythms are related to the anticipation of sensorimotor interaction between painful stimuli and movements: a high-resolution EEG study.J Pain. 2008; 9: 902-911
- The reliability and validity of measures of gait variability in community-dwelling older adults.Arch Phys Med Rehabil. 2008; 89: 2293-2296
- Associations between health-related quality of life and mortality in older adults.Prev Sci. 2015; 16: 21-30
- Special Issues in the Management of Chronic Pain in Older Adults.Pain Medicine. 2009; 10: S67-S78
- Toward a Transformed Understanding: From Pain and Movement to Pain With Movement.Physical therapy. 2016; 96: 1503-1507
- Age and gender differences in seven tests of functional mobility.J Neuroeng Rehabil. 2009; 6: 31
- Somatosensory attending to the lower back is associated with response speed of movements signaling back pain.Brain Res. 2019; 1723146383
- Hypervigilance for Bodily Sensations in the Back During a Movement Task in People With Chronic and Recurrent Low Back Pain.Clin J Pain. 2020; 36: 524-532
- Attentional Modulation of Somatosensory Processing During the Anticipation of Movements Accompanying Pain: An Event-Related Potential Study.J Pain. 2018; 19: 219-227
- Somatosensory attentional modulations during pain-related movement execution.Exp Brain Res. 2020; 238: 1169-1176
- Movement-evoked pain: transforming the way we understand and measure pain.Pain. 2019; 160: 757-761
- Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain.European Journal of Pain. 2011; 15: 213-219
- Pain Provocation and the Energy Cost of Walking: A Matched Comparison Study of Older Adults With and Without Chronic Low Back Pain With Radiculopathy.J Geriatr Phys Ther. 2019; 42: E97-e104
- Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations.Cochrane Database Syst Rev. 2016; Cd011145
- Measurement Properties of the Low Back Activity Confidence Scale (LoBACS).Evaluation & the health professions. 2016; 39: 204-214
- The bidirectional association between depressive symptoms and gait speed: evidence from the English Longitudinal Study of Ageing (ELSA).PLoS One. 2013; 8: e68632
- Report of the NIH Task Force on research standards for chronic low back pain.J Pain. 2014; 15: 569-585
- Core outcome measures for chronic pain clinical trials: IMMPACT recommendations.Pain. 2005; 113: 9-19
- Function and back symptoms in older adults.J Am Geriatr Soc. 2003; 51: 1702-1709
- Problem areas identified as important to older adults with lumbar spinal stenosis.Spine J. 2015; 15: 1636-1644
- Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study.J Am Geriatr Soc. 2014; 62: 1007-1016
- Comparing Pain Severity Versus Pain Location in the MOBILIZE Boston Study: Chronic Pain and Lower Extremity Function*.The Journals of Gerontology: Series A. 2009; 64A: 763-770
- Where does it hurt? Stability of recordings of pain location using the McGill Pain Map.J Rheumatol. 1996; 23: 1788-1793
- A method for scoring the pain map of the McGill Pain Questionnaire for use in epidemiologic studies.Aging (Milano). 1995; 7: 358-366
- Association of chronic pain with comorbidities and health care utilization: a retrospective cohort study using health administrative data.PAIN. 2021; 162: 2737-2749
- Distinctiveness of psychological obstacles to recovery in low back pain patients in primary care.PAIN®. 2010; 148: 398-406
- Psychometric properties of the 15-item geriatric depression scale in functionally impaired, cognitively intact, community-dwelling elderly primary care patients.J Am Geriatr Soc. 2005; 53: 1570-1576
- Toward Understanding Movement-evoked Pain (MEP) and its Measurement: A Scoping Review.Clin J Pain. 2021; 37: 61-78
- Quantitative sensory testing and predicting outcomes for musculoskeletal pain, disability, and negative affect: a systematic review and meta-analysis.Pain. 2019; 160: 1920-1932
- Measurement error and minimum detectable change in 4-meter gait speed in older adults.Aging Clin Exp Res. 2011; 23: 406-412
- Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery.J Gerontol A Biol Sci Med Sci. 2000; 55: M221-M231
- A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.J Gerontol. 1994; 49: M85-M94
- Mobility-related function in older adults: assessment with a 6-minute walk test.Arch Phys Med Rehabil. 1999; 80: 837-841
- Evaluation of the Iowa pain thermometer and other selected pain intensity scales in younger and older adult cohorts using controlled clinical pain: a preliminary study.Pain Med. 2007; 8: 585-600
- Psychometric properties of commonly used low back disability questionnaires: are they useful for older adults with low back pain?.Pain Med. 2009; 10: 85-94
- Classification of Geriatric Low Back Pain Based on Hip Characteristics with a 12-Month Longitudinal Exploration of Clinical Outcomes: Findings from Delaware Spine Studies.Phys Ther. 2021;
- Does Age Affect the Relationship Between Pain and Disability? A Descriptive Study in Individuals Suffering From Chronic Low Back Pain.J Geriatr Phys Ther. 2016; 39: 140-145
- The global burden of low back pain: estimates from the Global Burden of Disease 2010 study.Ann Rheum Dis. 2014; 73: 968-974
- Level of Low Back Pain–Related Disability Is Associated with Risk of Subsequent Falls in an Older Population: Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS).Pain Medicine. 2019; 20: 2377-2384
- A Standardized Assessment of Movement-evoked Pain Ratings Is Associated With Functional Outcomes in Older Adults With Chronic Low Back Pain.The Clinical Journal of Pain. 2022; 38: 241-249
- The Quebec Back Pain Disability Scale.Measurement properties. Spine (Phila Pa 1976). 1995; 20: 341-352
- Tests for physical function of the elderly with knee and hip osteoarthritis.Scandinavian journal of medicine & science in sports. 2001; 11: 280-286
- A systematic review of measures used to assess chronic musculoskeletal pain in clinical and randomized controlled clinical trials.J Pain. 2007; 8: 906-913
- Restricting back pain and subsequent mobility disability in community-living older persons.J Am Geriatr Soc. 2014; 62: 2142-2147
- Physical, Emotional, and Social Impacts of Restricting Back Pain in Older Adults: A Qualitative Study.Pain Med. 2017; 18: 1225-1235
- Restricting Back Pain and Subsequent Disability in Activities of Daily Living Among Community-Living Older Adults.J Aging Health. 2018; 30: 1482-1494
- Do older adults with chronic low back pain differ from younger adults in regards to baseline characteristics and prognosis?.Eur J Pain. 2017; 21: 866-873
- A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population.Pain. 2016; 157: 55-64
- A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Women.J Gerontol A Biol Sci Med Sci. 2016; 71: 1177-1183
- A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Men.J Gerontol A Biol Sci Med Sci. 2017; 72: 1264-1269
- Corticomotor control of lumbar multifidus muscles is impaired in chronic low back pain: concurrent evidence from ultrasound imaging and double-pulse transcranial magnetic stimulation.Exp Brain Res. 2016; 234: 1033-1045
- Corticomotor control of deep abdominal muscles in chronic low back pain and anticipatory postural adjustments.Exp Brain Res. 2012; 218: 99-109
- Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale.Psychiatry Res. 1992; 41: 237-248
- The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients.Quality of Life Research. 2020; 29: 275-287
- Prevalence and characteristics of widespread pain in female primary health care patients with chronic low back pain.Clin J Pain. 2012; 28: 65-72
- Temporal summation of mechanical pain prospectively predicts movement-evoked pain severity in adults with chronic low back pain.BMC musculoskeletal disorders. 2021; 22 (-429): 429
- Pain resilience moderates the influence of negative pain beliefs on movement-evoked pain in older adults.J Behav Med. 2020; 43: 754-763
- Associations between multimorbidity, healthcare utilisation and health status: evidence from 16 European countries.Age and Ageing. 2016; 45: 431-435
- Pain catastrophizing and kinesiophobia: predictors of chronic low back pain.Am J Epidemiol. 2002; 156: 1028-1034
- Catastrophization, fear of movement, anxiety, and depression are associated with persistent, severe low back pain and disability.The Spine Journal. 2020; 20: 857-865
- Back pain and decline in lower extremity physical function among community-dwelling older persons.J Gerontol A Biol Sci Med Sci. 2005; 60: 793-797
- The Reliability and Validity of a 6-Minute Walk Test as a Measure of Physical Endurance in Older Adults.Journal of Aging and Physical Activity. 1998; 6: 363-375
- The impact of chronic low back pain on older adults: a comparative study of patients and controls.Pain. 2007; 131: 293-301
- Predictors of Persistent Disability and Back Pain in Older Adults with a New Episode of Care for Back Pain.Pain Med. 2017; 18: 1049-1062
- Reliability and validity of three strength measures obtained from community-dwelling elderly persons.J Strength Cond Res. 2005; 19: 717-720
- Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain.Spine (Phila Pa 1976. 1998; 23: 2412-2421
- Paradigm Shift in Geriatric Low Back Pain Management: Integrating Influences, Experiences, and Consequences.Physical Therapy. 2018; 98: 434-446
- Static and Dynamic Pain Sensitivity in Adults with Persistent Low Back Pain: Comparison to Healthy Controls and Associations with Movement-Evoked Pain Versus Traditional Clinical Pain Measures.The Clinical journal of pain. 2021; 37: 494-503
- Gait speed and survival in older adults.Jama. 2011; 305: 50-58
- The pain catastrophizing scale: development and validation.Psychological assessment. 1995; 7: 524
- Activity-related summation of pain and functional disability in patients with whiplash injuries.Pain. 2010; 151: 440-446
- Psychological influences on repetition-induced summation of activity-related pain in patients with chronic low back pain.Pain. 2009; 141: 70-78
- Task-Specific Sensitivity in Physical Function Testing Predicts Outcome in Patients With Low Back Pain.Journal of Orthopaedic & Sports Physical Therapy. 2020; 50: 206-213
- Core outcome domains for chronic pain clinical trials: IMMPACT recommendations.Pain. 2003; 106: 337-345
- Pain-related factors contributing to muscle inhibition in patients with chronic low back pain: an experimental investigation based on superimposed electrical stimulation.Clin J Pain. 2005; 21: 232-240
- Differences between patients with chronic widespread pain and local chronic low back pain in primary care–a comparative cross-sectional analysis.BMC Musculoskelet Disord. 2013; 14: 351
- Psychometric Evaluation of the Revised Iowa Pain Thermometer (IPT-R) in a Sample of Diverse Cognitively Intact and Impaired Older Adults: A Pilot Study.Pain Manag Nurs. 2015; 16: 475-482
- Increased sensitivity to physical activity among individuals with knee osteoarthritis: relation to pain outcomes, psychological factors, and responses to quantitative sensory testing.Pain. 2014; 155: 703-711
- Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria.Scand J Pain. 2019; 20: 77-86
- The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.Arthritis Care Res (Hoboken). 2010; 62: 600-610
- Falling, health status, and the use of health services by older adults. A prospective study.Med Care. 1992; 30: 587-597
- Prevalence, Incidence, and Factors Associated With Non-Specific Chronic Low Back Pain in Community-Dwelling Older Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis.J Pain. 2022; 23: 509-534
- The Prospective Prognostic Value of Biopsychosocial Indices of Sensitivity to Physical Activity Among People With Back Pain.Clin J Pain. 2021; 37: 719-729
- Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017.Ann Transl Med. 2020; 8: 299
- New horizons in multimorbidity in older adults.Age and Ageing. 2017; 46: 882-888
Article info
Publication history
Accepted:
January 17,
2023
Received in revised form:
December 20,
2022
Received:
September 12,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© Published by Elsevier Inc. on behalf of United States Association for the Study of Pain, Inc.
