(366) Multisite pain among older adults with persistent back pain and its association with longitudinal outcomes

Self-Efficacy and Multisite Pain Predictors among Economically Disadvantaged Women with Back Pain

BACKGROUND

Chronic low back pain (CLBP) prevalence is higher among women and those with low socioeconomic status. Without adequate self-efficacy and subsequent self-management, patients gradually develop chronic multisite pain after one year of having CLBP alone.

AIM

This study investigated the predictors of self-efficacy and multisite pain among adult, economically disadvantaged women, where pain prevalence is higher.

DESIGN

Cross-sectional, descriptive study.

SETTING

Pain management center.

SUBJECTS

Participants (n = 50) with primary diagnosis of chronic low back pain.

METHODS

After Institutional Review Board approval, data collection was conducted using valid and reliable instruments measuring several variables. Controlling for age and race, multiple linear regression was used for analyses.

RESULTS AND CONCLUSIONS

For all predictors of self-efficacy, a significant regression equation was identified (p < .01) with R2 of .413 and variance of .643. Pain catastrophizing was a significant individual predictor (p < .05). A significant regression equation was also found for all predictors of multisite pain (p < .001) with R2 of .528 and variance of .726. Individual predictors (p < .05) were age, physical function, and numbers of pain treatments and chronic medical conditions. Study findings suggest that significant predictors can be key to advancing pain research, education, practice, and healthcare policy toward improving pain management. Particularly among this population, pain catastrophizing needs to be targeted in pain management. To minimize development of multisite pain, further investigation of identified predictors including number of chronic medical conditions and pain treatments received are necessary. Multimodal, but targeted approaches addressing these predictors are recommended, instead of costly, indiscriminate multimodal therapy. Targeted interventions can help reduce pain care disparities among socioeconomically disadvantaged women, identify high risk groups for prompt intervention, facilitate better pain response to treatments, and minimize further disability.

Chronic multisite pain: evaluation of a new geriatric syndrome

BACKGROUND

Chronic musculoskeletal pain is highly prevalent in the older adults, and individuals with musculoskeletal pain frequently report pain in two or more sites.

AIMS

To determine the prevalence and characteristics of multisite pain in relation to other geriatric syndromes and to evaluate whether multisite pain may represent a distinct geriatric syndrome.

METHODS

The MOBILIZE Boston Study is a population-based cohort study of older adults that enrolled 749 participants aged 70 and older. Persistent pain in the back and major joint areas was assessed using a joint pain questionnaire. Assessment of other geriatric syndromes included urinary incontinence, fall history, ADL disability, and frailty. A number of risk factors for geriatric syndromes were assessed.

RESULTS

The prevalence of multisite pain was 40% in this population of older adults. Many participants had more than one geriatric syndrome, indicating substantial overlap in the prevalence of these conditions. Nearly half (48%) of participants with urinary incontinence or falls, 61% with ADL disability, and 49% of those with frailty also had multisite pain. Shared risk factors for established geriatric conditions were similarly distributed among the elderly population who had multisite pain. Demographic and health characteristics associated with multisite pain and other geriatric syndromes, included gender (female), depression, number of comorbid conditions, and mobility limitations.

CONCLUSION

Although prior studies have explored risk factors for chronic multisite pain, these findings reveal that multisite pain, often unexplained, bears many similarities to established geriatric syndromes. Multisite pain warrants further consideration as a unique geriatric syndrome.