Is this back pain killing me? All‐cause and cardiovascular‐specific mortality in older Danish twins with spinal pain

Fernandez, Matthew; Boyle, Eleanor; Hartvigsen, Jan; Ferreira, Manuela L; Refshauge, Kathryn M.; Maher, Christopher G.; Christensen, Kaare; Hopper, John L.; Ferreira, Paulo H.

doi:10.1002/ejp.996

Cited by 23 publications

(26 citation statements)

References 54 publications

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“…First, our study compared those with the same injury, differing only in whether or not they experienced disability from that injury. Nevertheless, our results could be influenced by several confounders, which we are not able to control for in our study, such as smoking, obesity, and depression which are risk factors for disability and increase mortality from specific causes such as cancer, heart disease, and intentional self‐harm . On the other hand, the follow‐up period of our study occurred during a time of increased physician prescribing of opioids and the predictors of disability from low back pain have been found to be predominantly psychosocial variables and not perceived health status .…”

Section: Discussionmentioning

confidence: 64%

Increased overall and cause‐specific mortality associated with disability among workers’ compensation claimants with low back injuries

Martín

Jin

Bertke

et al. 2019

American J Industrial Med

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Section: Discussionmentioning

confidence: 64%

Increased overall and cause‐specific mortality associated with disability among workers’ compensation claimants with low back injuries

Martín

Jin

Bertke

et al. 2019

American J Industrial Med

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“…This work extends research on disabling back pain and increased mortality. 13,14 To our knowledge, our study is the first to measure disability after measurement of back pain, allowing prospective analysis of disability as a mediator of the association between back pain with mortality. Using causal mediation methods that incorporate interaction between exposure and mediator variables, 24,25 self-reported IADL impairment was an important mediator of this association.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15][16] Two studies separated back pain into multiple phenotypes based on pain frequency or impact on physical function, both found an elevated risk of mortality among older women. 14,15 Other studies dichotomized back pain exposure; of these, two observed a small increase in mortality among older adults but did not provide sex-specific results, 13,16 and five found no association. [8][9][10][11][12] All previous studies measured back pain at a single time point.…”

Section: Introductionmentioning

confidence: 99%

“…Disability might be one mechanism: studies found that disabling back pain increased mortality risk 16 and that baseline-level disability attenuated the association between back pain and mortality. 13 However, previous studies have not examined whether consequences of back pain contributed to early death (i.e., mediators [e.g., disability]). Such mediation analyses could identify pathways by which back pain may increase the risk of mortality.…”

Section: Introductionmentioning

confidence: 99%

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Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study

Roseen

LaValley

et al. 2018

J GEN INTERN MED

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BACKGROUND: The impact of back pain on disability in older women is well-understood, but the influence of back pain on mortality is unclear. OBJECTIVE: To examine whether back pain was associated with all-cause and cause-specific mortality in older women and mediation of this association by disability. DESIGN: Prospective cohort study. SETTING: The Study of Osteoporotic Fractures. PARTICIPANTS: Women aged 65 or older. MEASUREMENT: Our primary outcome, time to death, was assessed using all-cause and cause-specific adjusted Cox models. We used a four-category back pain exposure (no back pain, non-persistent, infrequent persistent, or frequent persistent back pain) that combined back pain frequency and persistence across baseline (1986-1988) and first follow-up (1989-1990) interviews. Disability measures (limitations of instrumental activities of daily living [IADL], slow chair stand time, and slow walking speed) from 1991 were considered a priori potential mediators. RESULTS: Of 8321 women (mean age 71.5, SD = 5.1), 4975 (56%) died over a median follow-up of 14.1 years. A higher proportion of women with frequent persistent back pain died (65.8%) than those with no back pain (53.5%). In the fully adjusted model, women with frequent persistent back pain had higher hazard of all-cause (hazard ratio [HR] = 1.24 [95% CI, 1.11-1.39]), cardiovascular (HR = 1.34 [CI, 1.12-1.62]), and cancer (HR = 1.33, [CI 1.03-1.71]) mortality. No association with mortality was observed for other back pain categories. In mediation analyses, IADL limitations explained 47% of the effect of persistent frequent back pain on all-cause mortality, slow chair stand time, and walking speed, explained 27% and 24% (all significant, p < 0.001), respectively. LIMITATIONS: Only white women were included. CONCLUSION: Frequent persistent back pain was associated with increased mortality in older women. Much of this association was mediated by disability.

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“…12 Evidence also shows an association between LBP and increased risk of mortality in older adults per year lived, although the association does not seems to be causal. 13 Furthermore, compared with pain-free individuals, older adults with LBP have more psychosocial dysfunction, self-reported disability, and physical performance impairments, 14 that may contribute to a worse trajectory of the symptoms. 15 As life expectancy increases, 16 the number of older adults with back complaints tends to be higher, contributing for more years living with disabilities.…”

mentioning

confidence: 99%

Exclusion of Older Adults from Ongoing Clinical Trials on Low Back Pain: A Review of the WHO Trial Registry Database

Nascimento

Ferreira

Poitras

et al. 2018

J American Geriatrics Society

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Background/Objectives The burden of low back pain (LBP) is high, especially for older adults who experience a higher number of years living with a disability. However, this population is not being well represented in clinical trials (CTs). This study analyzed the International Clinical Trial Registry Platform (ICTRP) database from the World Health Organization to verify the future trend in the participation of older adults in registered CTs on LBP. Design We performed a cross‐sectional review of the ICTRP searching for prospective protocols planning interventions for LBP with registration dates from January 2015 through November 2018. From the protocols of the eligible studies, we extracted those planning to include older adults. Results A total of 167 protocols for CTs for LBP were planning to recruit participants older than 65 years. However, only five registries (2.99%; pooled sample = 169 participants) were designed to target participants specifically older than 65 years. The exclusion of older participants was not justified and imposed through an arbitrary upper‐age limit in 93.6% of the protocols. Most of the protocols are from single‐center studies, and a greater number are planned to be carried out in developed regions. Higher interest was in pharmacologic interventions, devices/technology, and physical rehabilitation. Conclusion Older adults with LBP will continue to be underinvestigated in CTs for LBP in the near future. In general, ongoing trials are small, planned in developed regions, and proposing pharmacologic interventions to deal with LBP. J Am Geriatr Soc 67:603–608, 2019.

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Is this back pain killing me? All‐cause and cardiovascular‐specific mortality in older Danish twins with spinal pain

Cited by 23 publications

References 54 publications

Increased overall and cause‐specific mortality associated with disability among workers’ compensation claimants with low back injuries

Increased overall and cause‐specific mortality associated with disability among workers’ compensation claimants with low back injuries

Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study

Exclusion of Older Adults from Ongoing Clinical Trials on Low Back Pain: A Review of the WHO Trial Registry Database

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