Hồ sơ Sinh học Tâm lý Xã hội và Các Mối Liên Hệ Chức Năng ở Người Cao Tuổi Bị Đau Lưng Mạn Tính: Một Nghiên Cứu Sơ Bộ
Tóm tắt
Mô tả các tình trạng thần kinh ngoại vi và trung ương (CNS) chính ở nhóm người cao tuổi có đau lưng mạn tính (CLBP) và mối liên hệ của chúng với mức độ đau và chức năng thể chất tự khai báo cũng như dựa trên hiệu suất.
Nghiên cứu cắt ngang.
Các phòng khám ngoại trú của VA.
Bốn mươi bảy cựu chiến binh sống tại cộng đồng có CLBP (tuổi 68.0 ± 6.5 năm, khoảng 60–88 năm, 12.8% là nữ, 66% là người da trắng) đã tham gia.
Dữ liệu được thu thập về các yếu tố gây đau ngoại vi—chỉ số khối cơ thể, tiêu chuẩn viêm xương khớp hông của Hội Mỹ khoa học Thấp khớp, đau do thiếu máu cục bộ (tức là, hẹp tủy sống), đau khớp cùng chậu (SIJ), đau cơ xơ, sự chênh lệch chiều dài chân (LLD), và đau dải iliotibial; và các yếu tố gây đau CNS—lo âu (GAD-7), trầm cảm (PHQ-9), chứng mất ngủ (Chỉ số Mất ngủ), đối phó không thích hợp (Bảng câu hỏi Niềm tin Tránh né, Bảng câu hỏi Chiến lược Nhận thức), và hội chứng đau cơ xơ hóa (khảo sát bệnh lý cơ xơ hóa). Các kết quả bao gồm mức độ đau (thang điểm từ 0 đến 10, trung bình bảy ngày và tồi tệ nhất), ảnh hưởng của đau tự khai báo (bảng hỏi Roland Morris [RM]), và tốc độ đi lại.
Khoảng 96% có ít nhất một yếu tố góp phần CLBP ngoại vi, 83% có ít nhất một yếu tố góp phần CNS, và 80.9% có cả yếu tố góp phần ngoại vi và trung ương. Trong số các tình trạng ngoại vi, chỉ có đau SIJ và LLD có liên quan đến các kết quả. Tất cả các tình trạng CNS và đau SIJ đều có liên quan đến điểm số RM. Chỉ có trầm cảm/lo âu và LLD có liên quan đến tốc độ đi lại.
Trong mẫu nghiên cứu này của những cựu chiến binh lớn tuổi, CLBP là một tình trạng đa diện. Cả các tình trạng CNS và ngoại vi đều liên quan đến chức năng tự khai báo và dựa trên hiệu suất. Cần thiết phải điều tra thêm để xác định tác động của việc điều trị các tình trạng này lên kết quả của bệnh nhân và việc sử dụng dịch vụ y tế.
Từ khóa
Tài liệu tham khảo
Deyo, 2014, Report of the NIH task force on research standards for chronic low back pain, J Pain, 15, 569, 10.1016/j.jpain.2014.03.005
Dieleman, 2016, US spending on personal health care and public health, 1996-2013, JAMA, 316, 2627, 10.1001/jama.2016.16885
Dagenais, 2008, A systematic review of low back pain cost of illness studies in the United States and internationally, Spine J, 8, 8, 10.1016/j.spinee.2007.10.005
Gore, 2012, The burden of chronic low back pain: Clinical comorbidities, treatment patterns, and health care costs in usual care settings, Spine (Phila Pa 1976), 37, E668, 10.1097/BRS.0b013e318241e5de
Reid, 2005, Back pain and decline in lower extremity physical function among community-dwelling older persons, J Gerontol A Biol Sci Med Sci, 60, 793, 10.1093/gerona/60.6.793
Edmond, 2003, Function and back symptoms in older adults, J Am Geriatr Soc, 51, 1702, 10.1046/j.1532-5415.2003.51553.x
Rudy, 2007, The impact of chronic low back pain on older adults: A comparative study of patients and controls, Pain, 131, 293, 10.1016/j.pain.2007.01.012
Meyer, 2007, Disabling low back pain and depressive symptoms in the community dwelling elderly: A prospective study, Spine, 32, 2380, 10.1097/BRS.0b013e3181557955
Robins, 1984, Lifetime prevalence of specific psychiatric disorders in three sites, Arch Gen Psychiatry, 41, 949, 10.1001/archpsyc.1984.01790210031005
Polatin, 1993, Psychiatric illness and chronic low-back pain: The mind and the spine—which goes first?, Spine, 18, 66, 10.1097/00007632-199301000-00011
Atkinson, 1991, Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: A controlled study, Pain, 45, 111, 10.1016/0304-3959(91)90175-W
Weiner, 2006, The relationship between pain, neuropsychological performance, and physical function in community-dwelling older adults with chronic low back pain, Pain Med, 7, 60, 10.1111/j.1526-4637.2006.00091.x
Bosley, 2004, Is chronic nonmalignant pain associated with decreased appetite in older adults? Preliminary evidence, J Am Geriatr Soc, 52, 247, 10.1111/j.1532-5415.2004.52063.x
Chen, 2011, Characteristics of chronic pain associated with sleep difficulty in older adults: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston study, J Am Geriatr Soc, 59, 1385, 10.1111/j.1532-5415.2011.03544.x
Mackichan, 2013, ‘Living within your limits’: Activity restriction in older people experiencing chronic pain, Age Ageing, 42, 702, 10.1093/ageing/aft119
Chou, 2007, Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society, Ann Intern Med, 147, 478, 10.7326/0003-4819-147-7-200710020-00006
Martin, 2008, Expenditures and health status among adults with back and neck problems, JAMA, 299, 656, 10.1001/jama.299.6.656
Hicks, 2009, Degenerative lumbar disc and facet disease in older adults: Prevalence and clinical correlates, Spine, 34, 1301, 10.1097/BRS.0b013e3181a18263
Jarvik, 2001, The longitudinal assessment of imaging and disability of the back (LAIDBack) study: Baseline data, Spine, 26, 1158, 10.1097/00007632-200105150-00014
Cayea, 2006, Chronic low back pain in older adults: What physicians know, what they think they know, and what they should be taught, J Am Geriatr Soc, 54, 1772, 10.1111/j.1532-5415.2006.00883.x
Gatchel, 2014, Interdisciplinary chronic pain management: Past, present, and future, Am Psychol, 69, 119, 10.1037/a0035514
Stanos, 2012, Focused review of interdisciplinary pain rehabilitation programs for chronic pain management, Curr Pain Headache Rep, 16, 147, 10.1007/s11916-012-0252-4
Qaseem, 2017, Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians, Ann Intern Med, 166, 514, 10.7326/M16-2367
Guzmán, 2001, Multidisciplinary rehabilitation for chronic low back pain: Systematic review, BMJ, 322, 1511, 10.1136/bmj.322.7301.1511
Wittink, 2006, Older and younger adults in pain management programs in the United States: Differences and similarities, Pain Med, 7, 151, 10.1111/j.1526-4637.2006.00113.x
Reid, 2003, Depressive symptoms as a risk factor for disabling back pain in community-dwelling older persons, J Am Geriatr Soc, 51, 1710, 10.1046/j.1532-5415.2003.51554.x
Rundell, 2017, Predictors of persistent disability and back pain in older adults with a new episode of care for back pain, Pain Med, 18, 1049
Weiner, 2015, Deconstructing chronic low back pain in the older adult: Shifting the paradigm from the spine to the person, Pain Med, 16, 881, 10.1111/pme.12759
Weiner, 2015, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment. Part I: Hip osteoarthritis, Pain Med, 16, 886, 10.1111/pme.12757
Lisi, 2015, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment. Part II: Myofascial pain, Pain Med, 16, 1282, 10.1111/pme.12821
Fatemi, 2015, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment. Part III: Fibromyalgia syndrome, Pain Med, 16, 1709, 10.1111/pme.12863
Carley, 2015, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment. Part IV: Depression, Pain Med, 16, 2098, 10.1111/pme.12935
DiNapoli, 2016, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment. Part V: Maladaptive coping, Pain Med, 17, 64, 10.1093/pm/pnv055
Fritz, 2016, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment. Part VI: Lumbar spinal stenosis, Pain Med, 17, 501, 10.1093/pm/pnw011
Bramoweth, 2016, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment. Part VII: Insomnia, Pain Med, 17, 851, 10.1093/pm/pnw063
Rho, 2016, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment: Part VIII: Lateral hip and thigh pain, Pain Med, 17, 1249, 10.1093/pm/pnw111
Karp, 2016, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment: Part IX: Anxiety, Pain Med, 17, 1423, 10.1093/pm/pnw135
Polsunas, 2016, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment: Part X: Sacroiliac joint syndrome, Pain Med, 17, 1638, 10.1093/pm/pnw151
Wright, 2016, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment. Part XI: Dementia, Pain Med, 17, 1993, 10.1093/pm/pnw247
Havran, 2016, Deconstructing chronic low back pain in the older adult—step by step evidence and expert-based recommendations for evaluation and treatment: Part XII: Leg length discrepancy, Pain Med, 17, 2230, 10.1093/pm/pnw270
Weiner, 2016, Deconstructing chronic low back pain in older adults: Summary recommendations, Pain Med, 17, 2238, 10.1093/pm/pnw267
Roland, 1983, A study of the natural history of back pain. Part 1: Development of a reliable and sensitive measure of disability in low back pain, Spine, 8, 141, 10.1097/00007632-198303000-00004
Gluhm, 2013, Cognitive performance on the Mini-Mental State Examination and the Montreal Cognitive Assessment across the healthy adult lifespan, Cogn Behav Neurol, 26, 1, 10.1097/WNN.0b013e31828b7d26
Kroenke, 2001, The PHQ-9: Validity of a brief depression severity measure, J Gen Intern Med, 16, 606, 10.1046/j.1525-1497.2001.016009606.x
Kroenke, 2009, Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain, JAMA, 301, 2099, 10.1001/jama.2009.723
Spitzer, 2006, Lowe B. A brief measure for assessing generalized anxiety disorder, Arch Intern Med, 166, 1092, 10.1001/archinte.166.10.1092
Almeida, 2012, Anxiety, depression, and comorbid anxiety and depression: Risk factors and outcome over two years, Int Psychogeriatr, 24, 1622, 10.1017/S104161021200107X
Bastien, 2001, Validation of the Insomnia Severity Index as an outcome measure for insomnia research, Sleep Med, 2, 297, 10.1016/S1389-9457(00)00065-4
Alsaadi, 2011, Prevalence of sleep disturbance in patients with low back pain, Eur Spine J, 20, 737, 10.1007/s00586-010-1661-x
Agmon, 2014, Increased insomnia symptoms predict the onset of back pain among employed adults, PLoS One, 9, e103591, 10.1371/journal.pone.0103591
Rosenstiel, 1983, The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment, Pain, 17, 33, 10.1016/0304-3959(83)90125-2
Waddell, 1993, A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability, Pain, 52, 157, 10.1016/0304-3959(93)90127-B
Sions, 2011, Fear-avoidance beliefs are associated with disability in older American adults with low back pain, Phys Ther, 91, 525, 10.2522/ptj.20100131
George, 2008, Investigation of elevated fear-avoidance beliefs for patients with low back pain: A secondary analysis involving patients enrolled in physical therapy clinical trials, J Orthop Sports Phys Ther, 38, 50, 10.2519/jospt.2008.2647
Altman, 1991, The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip, Arthritis Rheum, 34, 505, 10.1002/art.1780340502
Wolfe, 1990, The American College of Rheumatology 1990 criteria for the classification of fibromyalgia, Arthritis Rheum, 33, 160, 10.1002/art.1780330203
Wolfe, 2011, Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the ACR preliminary diagnostic criteria for fibromyalgia, J Rheumatol, 38, 1113, 10.3899/jrheum.100594
Iglesias-González, 2013, Myofascial trigger points, pain, disability, and sleep quality in patients with chronic nonspecific low back pain, Pain Med, 14, 1964, 10.1111/pme.12224
Abellan Van Kan, 2009, Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people: An International Academy on Nutrition and Aging (IANA) Task Force, J Nutr Health Aging, 13, 881, 10.1007/s12603-009-0246-z
Hicks, 2017, Altered spatiotemporal characteristics of gait in older adults with chronic low back pain, Gait Posture, 55, 172, 10.1016/j.gaitpost.2017.04.027
Perera, 2016, Gait speed predicts incident disability: A pooled analysis, J Gerontol A Biol Sci Med Sci, 71, 63, 10.1093/gerona/glv126
Monticone, 2012, Responsiveness of the Oswestry Disability Index and the Roland Morris Disability Questionnaire in Italian subjects with sub-acute and chronic low back pain, Eur Spine J, 21, 122, 10.1007/s00586-011-1959-3
Roland, 2000, The Roland–Morris disability questionnaire and the Oswestry Disability Questionnaire, Spine, 25, 3115, 10.1097/00007632-200012150-00006
Perera, 2006, Meaningful change and responsiveness in common physical performance measures in older adults, J Am Geriatr Soc, 54, 743, 10.1111/j.1532-5415.2006.00701.x
Perera, 2014, Are estimates of meaningful decline in mobility performance consistent among clinically important subgroups? (Health ABC Study), J Gerontol A Biol Sci Med Sci, 69, 1260, 10.1093/gerona/glu033
Guralnik, 1994, A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission, J Gerontol, 49, M85, 10.1093/geronj/49.2.M85
Morone, 2016, A mind body program for older adults with chronic low back pain: A randomized clinical trial, JAMA Intern Med, 176, 329, 10.1001/jamainternmed.2015.8033
Trivedi, 2015, Prevalence, comorbidity, and prognosis of mental health among US veterans, Am J Public Health, 105, 2564, 10.2105/AJPH.2015.302836
Vlaeyen, 2000, Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art, Pain, 85, 317, 10.1016/S0304-3959(99)00242-0
Lerman, 2017, The role of catastrophising in rheumatic diseases, Clin Exp Rheumatol, 35(suppl 107), 32
Weiner, 2006, Chronic low back pain in older adults: Prevalence, reliability, and validity of physical examination findings, J Am Geriatr Soc, 54, 11, 10.1111/j.1532-5415.2005.00534.x
Weiner, 2004, Do medical factors predict disability in older adults with persistent low back pain?, Pain, 112, 214, 10.1016/j.pain.2004.08.027