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Pain Med. 2019 Jan 5. doi: 10.1093/pm/pny270. [Epub ahead of print]

Multisite Pain Is Associated with Long-term Patient-Reported Outcomes in Older Adults with Persistent Back Pain.

Author information

1
Department of Rehabilitation Medicine.
2
Comparative Effectiveness, Cost, and Outcomes Research Center.
3
Department of Health Services.
4
Department of Anesthesiology and Pain Medicine.
5
Department of Psychology.
6
Department of Biostatistics, University of Washington, Seattle, Washington.
7
VA Puget Sound Health Care System, Seattle, Washington.
8
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
9
Department of Family Medicine.
10
Department of Medicine, Oregon Health & Science University, Portland, Oregon.
11
Seattle Children's Research Institute, Seattle, Washington.
12
Neuroscience Institute, Henry Ford Hospital, Detroit, Michigan.
13
Division of Research, Kaiser Permanente Northern California, Oakland, California.
14
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, and Spine Unit, Harvard Vanguard Medical Associates, Boston, Massachusetts.
15
Department of Radiology.
16
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.

Abstract

Objective:

To estimate the prevalence of co-occurring pain sites among older adults with persistent back pain and associations of multisite pain with longitudinal outcomes.

Design:

Secondary analysis of a cohort study.

Setting:

Three integrated health systems in the United States.

Subjects:

Eight hundred ninety-nine older adults with persistent back pain.

Methods:

Participants reported pain in the following sites: stomach, arms/legs/joints, headaches, neck, pelvis/groin, and widespread pain. Over 18 months, we measured back-related disability (Roland Morris, scored 0-24), pain intensity (11-point numerical rating scale), health-related quality of life (EuroQol-5D [EQ-5D], utility from 0-1), and falls in the past three weeks. We used mixed-effects models to test the association of number and type of pain sites with each outcome.

Results:

Nearly all (N = 839, 93%) respondents reported at least one additional pain site. There were 216 (24%) with one additional site and 623 (69%) with multiple additional sites. The most prevalent comorbid pain site was the arms/legs/joints (N = 801, 89.1%). Adjusted mixed-effects models showed that for every additional pain site, RMDQ worsened by 0.65 points (95% confidence interval [CI] = 0.43 to 0.86), back pain intensity increased by 0.14 points (95% CI = 0.07 to 0.22), EQ-5D worsened by 0.012 points (95% CI = -0.018 to -0.006), and the odds of falling increased by 27% (odds ratio = 1.27, 95% CI = 1.12 to 1.43). Some specific pain sites (extremity pain, widespread pain, and pelvis/groin pain) were associated with greater long-term disability.

Conclusions:

Multisite pain is common among older adults with persistent back pain. Number of pain sites was associated with all outcomes; individual pain sites were less consistently associated with outcomes.

PMID:
30615144
DOI:
10.1093/pm/pny270

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