Department of Physical Therapy, University of Delaware, Newark, Delaware.
Department of Orthopaedic Surgery, Physical Therapy Division, Duke University, Durham, North Carolina.
J Pain. 2023 Jun;24(6):980-990. doi: 10.1016/j.jpain.2023.01.012. Epub 2023 Jan 24.
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 (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 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 (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b = -.562, t = -2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .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.
目前尚不清楚哪些与疼痛相关的因素会导致慢性下背痛（LBP）的老年患者长期残疾和健康状况较差。本研究旨在探讨运动诱发疼痛（MeP）和广泛疼痛（WP）对 250 名慢性 LBP 老年患者纵向健康结局（即步态速度、感知残疾和自我效能）的独特影响。MeP 通过 3 项标准化功能测试引出，而 WP 的存在则来自麦吉尔疼痛图。使用 HC3 标准误差的稳健回归来检验这些基线疼痛变量与 12 个月随访时健康结局之间的关联。这些模型的协变量包括年龄、性别、体重指数、静息和回忆性 LBP 强度、LBP 持续时间、抑郁、疼痛灾难化和基线结局（例如，基线步态速度）。更大的 MeP 与 12 个月时 LBP 相关残疾的恶化（b=0.384，t=2.013，P=0.046）和自我效能的降低（b=-0.562，t=-2.074，P=0.039）独立相关；但与步态速度无关（P>0.05）。相比之下，WP 和静息及回忆性 LBP 强度在调整后与任何前瞻性健康结局均无关（均 P>0.05）。与 WP 和静息及回忆性 LBP 强度相比，MeP 与慢性 LBP 老年患者的纵向健康结局关系最密切。观点：本文在慢性 LBP 的老年患者中确立了 MeP 与 12 个月时感知残疾和自我效能下降之间的新的独立关联。MeP 可能具有生物心理社会基础和后果，因此可能是 LBP 和其他老年慢性疼痛人群健康结局的重要决定因素。
