Trajectories of Symptoms and Function in Older Adults With Low Back Disorders

Deyo, Richard A.; Bryan, Matthew; Comstock, Bryan A.; Turner, Judith A.; Heagerty, Patrick J.; Friedly, Janna; Avins, Andrew L.; Nedeljković, Srdjan S.; Nerenz, David R.; Jarvik, Jeffrey G.

doi:10.1097/brs.0000000000000975

Cited by 65 publications

(80 citation statements)

References 19 publications

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“…Notably, although nearly two-thirds of this sample experienced clinically meaningful reductions in pain intensity over 12 months, a substantial minority of veterans did not experience reductions in pain intensity and, in some cases, some experienced pain exacerbations. Indeed, some recent studies have shown that groups of patients with differing pain outcome trajectories can be identified and characterized 19, 23, 40 . Study findings call for further development of strategies that identify and target older individuals who have, or are more likely to have, treatment-refractory chronic pain.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Improvements in Pain Intensity in a National Cohort of Older Veterans With Chronic Pain

Dobscha

Lovejoy

Morasco

et al. 2016

The Journal of Pain

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Little is known about the factors associated with pain-related outcomes in older adults. In this observational study, we sought to identify patient factors associated with improvements in pain intensity in a national cohort of older veterans with chronic pain. We included 12,924 veterans receiving treatment from the Veterans Health Administration with persistently elevated numeric rating scale scores in 2010 who had not been prescribed opioids in the prior 12 months. We examined 1) percentage decrease over 12 months in average pain intensity scores relative to average baseline pain intensity score; and 2) time to sustained improvement in average pain intensity scores, defined as a 30% reduction in 3-month scores compared to baseline. Average relative improvement in pain intensity scores from baseline ranged from 25% to 29%; almost two-thirds met criteria for sustained improvement during the 12-month follow-up period. In models, higher baseline pain intensity and older age were associated with greater likelihood of improvement in pain intensity, while VA service-connected disability, mental health, and certain pain-related diagnoses were associated with lower likelihood of improvement. Opioid prescription initiation during follow-up was associated with lower likelihood of sustained improvement. The findings call for further characterization of heterogeneity in pain outcomes in older adults as well as further analysis of the relationship between prescription opioids and treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Predictors of Improvements in Pain Intensity in a National Cohort of Older Veterans With Chronic Pain

Dobscha

Lovejoy

Morasco

et al. 2016

The Journal of Pain

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“…Although these studies have methodologic differences, they have identified common trajectories of persistent, recovery, and developing back pain . Some of these studies have examined factors associated with the back pain trajectories identified ; however, none have compared health‐related outcomes in the back pain trajectory groups identified in the current study. Whether the patterns of back pain over time observed in the clinical samples of prior studies are also seen in the general population remains to be examined.…”

Section: Introductionmentioning

confidence: 97%

“…Previous studies have examined the trajectories of back pain . The majority of these involved patients who presented to primary care settings with back pain , had a restricted age range , and/or had short follow‐up times (≤1 year) . Only a few studies have examined back pain in the general population using a wide age range .…”

Section: Introductionmentioning

confidence: 99%

Course of Back Pain in the Canadian Population: Trajectories, Predictors, and Outcomes

Cañizares

Rampersaud

Badley

2019

Arthritis Care & Research

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Objective. To identify and describe back pain trajectory groups and to compare indicators of health status, medication, and health care use in these groups.Methods. A representative sample (n = 12,782) of the Canadian population was followed-up from 1994/1995 to 2010/2011. Participants were interviewed biannually and provided data on sociodemographic (e.g., education) and behavior-related (e.g., physical activity) factors, depression, comorbidities, pain, disability, medication use (e.g., opioids), and health care use (e.g., primary care visits). We used group-based trajectory analysis to categorize participants according to patterns in the course of their back pain during the 16-year follow-up period and compared indicators of pain, disability, medication, and health care use in the trajectory groups.Results. A total of 45.6% of the participants reported back pain at least once during follow-up. Of those, we identified 4 trajectories: persistent (18.0%), developing (28.1%), recovery (20.5%), and occasional (33.4%). The persistent and developing groups were characterized as having pain that prevented activities, disability, depression, and comorbidities. There were significant differences in the patterns of medication and health care use across the groups, with a general trend of most to least health care and medication use in the persistent, developing, recovering, and occasional groups. Those in the recovery group had an increasing trajectory reflecting opioid and antidepressant use.Conclusion. Approximately 1 in 5 people with back pain experience a persistent pain trajectory with an associated increase in pain, disability, and health care use. Further research is needed to determine whether the groups identified represent different diagnoses, which may provide insight into the selection of stratified treatment and aid in designing early prevention and management strategies in the population.

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“…Such new information could potentially help with the important efforts of identifying subpopulations of LBP patients who respond best to various types of treatments. 57,58 …”

Section: Limitations and Future Researchmentioning

confidence: 99%

A Feasibility Study to Assess Vibration and Sound From Zygapophyseal Joints During Motion Before and After Spinal Manipulation

Cramer

Budavich

Bora

et al. 2017

Journal of Manipulative and Physiological Therapeutics

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Objective This feasibility study used novel accelerometry (vibration) and microphone (sound) methods to assess crepitus originating from the lumbar spine before and after side-posture spinal manipulation (SMT). Methods This study included 5 healthy and 5 low back pain (LBP) subjects. Nine accelerometers and 1 specialized directional microphone were applied to the lumbar region, allowing assessment of crepitus. Each subject underwent full lumbar ranges of motion (ROM), bilateral lumbar SMT, and repeated full ROM. Following full ROMs the subjects received side-posture lumbar SMT on both sides by a licensed doctor of chiropractic. Accelerometer and microphone recordings were made during all pre- and post-SMT ROMs. Primary outcome was a descriptive report of crepitus prevalence (average number of crepitus events/subject). Subjects were also divided into 3 age groups for comparisons (18–25, 26–45, and 46–65 years). Results Overall, crepitus prevalence decreased pre-post SMT (average pre= 1.4 crepitus/subject vs. post= 0.9). Prevalence progressively increased from the youngest to oldest age groups (pre-SMT= 0.0, 1.67, and 2.0, respectively; and post-SMT= 0.5, 0.83, and 1.5). Prevalence was higher in LBP subjects compared to healthy (pre-SMT-LBP= 2.0, vs. pre-SMT-healthy= 0.8; post-SMT-LBP= 1.0 vs. post-SMT-healthy= 0.8), even though healthy subjects were older than LBP subjects (40.8 years vs. 27.8 years); accounting for age: pre-SMT-LBP= 2.0 vs. pre-SMT-healthy= 0.0; post-SMT-LBP= 1.0 vs. post-SMT-healthy= 0.3. Conclusions Our findings showed that a larger study is feasible. Other findings included that crepitus prevalence increased with age, was higher in LBP than healthy subjects, and overall decreased following SMT. This study showed that crepitus assessment using accelerometers has the potential of being an outcome measure/biomarker for assessing spinal joint (facet/Z joint) function during movement and the effects of LBP treatments (eg, SMT) on Z joint function.

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Trajectories of Symptoms and Function in Older Adults With Low Back Disorders

Abstract: 3.

Cited by 65 publications

References 19 publications

Predictors of Improvements in Pain Intensity in a National Cohort of Older Veterans With Chronic Pain

Predictors of Improvements in Pain Intensity in a National Cohort of Older Veterans With Chronic Pain

Course of Back Pain in the Canadian Population: Trajectories, Predictors, and Outcomes

A Feasibility Study to Assess Vibration and Sound From Zygapophyseal Joints During Motion Before and After Spinal Manipulation

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