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Movement-Evoked Pain Versus Widespread Pain: A Longitudinal Comparison in Older Adults with Chronic Low Back Pain from the Delaware Spine Studies

Published:January 24, 2023DOI:https://doi.org/10.1016/j.jpain.2023.01.012

      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

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