Functional pain severity and mobility in overweight older men and women with chronic low-back pain--part I

Walking performance in individuals with lumbar spinal stenosis-possible outcome measures and assessment of known-group validity

BACKGROUND CONTEXT

One of the primary goals of treatments received by individuals with lumbar spinal stenosis with neurogenic claudication is to improve walking ability. Thus, a thorough and valid assessment of walking ability in patients with lumbar spinal stenosis is needed. Duration of continuous walking and steps per day could be relevant when evaluating walking ability in daily living.

PURPOSE

To describe and evaluate a method for estimating continuous walking periods in daily living and to evaluate the known-group validity of steps per day in individuals with lumbar spinal stenosis.

STUDY DESIGN

This is a cross-sectional observational study.

PATIENT SAMPLE

The study contains three study groups: individuals with lumbar spinal stenosis, individuals with low back pain, and a background population from the Lolland-Falster Health Study (LOFUS).

OUTCOME MEASURES

Participants in all three study groups wore an accelerometer on the thigh for seven days.

METHODS

Accelerometer data were processed to summarize the continuous walking periods according to their length: the number of short (4-9 seconds), moderate (10-89 seconds), and extended (≥90 seconds) continuous walking periods per day, and the number of steps per day. Results from the three groups were compared using negative binomial regression with lumbar spinal stenosis as the reference level.

RESULTS

Continuous walking periods of moderate length were observed 1.48 (95% CI 1.27, 1.72) times more often in individuals from the background population than in individuals with LSS. Continuous walking periods of extended length were observed 1.53 (95% CI 1.13, 2.06) times more often by individuals with low back pain and 1.60 (95% CI 1.29, 1.99) times more often by individuals from the background population. The number of steps per day was 1.22 (95% CI 1.03, 1.46) times larger in individuals with LBP and 1.35 (95% CI 1.20, 1.53) times larger in individuals from background population.

CONCLUSIONS

The impact of neurogenic claudication on walking ability in daily living seems possible to describe by continuous walking periods along with steps per day. The results support known-group validity of steps per day. This is the next step toward a clinically relevant and comprehensive assessment of walking in daily living in individuals with lumbar spinal stenosis.

Adults with excess weight or obesity, but not with overweight, report greater pain intensities than individuals with normal weight: a systematic review and meta-analysis

Context

Over 1.9 billion adult people have overweight or obesity. Considered as a chronic disease itself, obesity is associated with several comorbidities. Chronic pain affects approximately 60 million people and its connection with obesity has been displayed in several studies. However, controversial results showing both lower and higher pain thresholds in subjects with obesity compared to individuals with normal weight and the different parameters used to define such association (e.g., pain severity, frequency or duration) make it hard to draw straight forward conclusions in the matter. The objective of this article is to examine the relationship between overweight and obesity (classified with BMI as recommended by WHO) and self-perceived pain intensity in adults.

Methods

A literature search was conducted following PRISMA guidelines using the databases CINAHL, Cochrane Library, EMBASE, PEDro, PubMed, Scopus and Web of Science to identify original studies that provide BMI values and their associated pain intensity assessed by self-report scales. Self-report pain scores were normalized and pooled within meta-analyses. The Cochrane's Q test and I2 index were used to clarify the amount of heterogeneity; meta-regression was performed to explore the relationship between each outcome and the risk of bias.

Results

Of 2194 studies, 31 eligible studies were identified and appraised, 22 of which provided data for a quantitative analysis. The results herein suggested that adults with excess weight (BMI ≥ 25.0) or obesity (BMI ≥ 30.0) but not with overweight (pre-obesity) alone (BMI 25.0-29.9), are more likely to report greater intensities of pain than individuals of normal weight (BMI 18.5-24.9). Subgroup analyses regarding the pathology of the patients showed no statistically significant differences between groups. Also, influence of age in the effect size, evaluated by meta-regression, was only observed in one of the four analyses. Furthermore, the robustness of the findings was supported by two different sensitivity analyses.

Conclusion

Subjects with obesity and excess weight, but not overweight, reported greater pain intensities than individuals with normal weight. This finding encourages treatment of obesity as a component of pain management. More research is required to better understand the mechanisms of these differences and the clinical utility of the findings.

Systematic Review Registration

https://doi.org/10.17605/OSF.IO/RF2G3, identifier OSF.IO/RF2G3.

Avoidance-Endurance Model in Older Black Men with Low Back Pain: Exploring Relationships

OBJECTIVE

The objective of the study was to investigate functional performance and pain intensity outcomes for associations with negative cognitive orientations, avoidance behaviors, and fear of pain in older Black men with low back pain (LBP).

METHODS

Sixty Black men aged 60 and older (70 years[Formula: see text]) with LBP completed the Short Physical Performance Battery (SPPB), the 400-m walk test, and subjective measures of avoidance behaviors, back performance, pain intensity, and pain catastrophizing (i.e., rumination, magnification, and helplessness). Multiple regression models were used to examine associations.

RESULTS

Higher helplessness scores were associated with worse back performance (ß = 0.55, p = 0.02), slower walking speed (ß = 0.30, p = 0.02), and higher average pain intensity (ß = 0.22, [Formula: see text] p = 0.03). Higher rumination scores were associated with better back performance (ß =  - 0.36, p = 0.04). Avoidance behaviors, fear of pain, and magnification were not significantly associated with any of the variables included in the tested models.

CONCLUSION

Negative cognitive internalization is associated with limitations in functional performance in older Black men with LBP. Additional research is needed to further examine the cognitive orientations for understanding experienced pain and function in this population. Such research may inform the development of interventions for improving functional performance outcomes of older Black men with LBP.

Quantitative Sensory Testing in Adolescents with Co-occurring Chronic Pain and Obesity: A Pilot Study

Factors such as gender, ethnicity, and age affect pain processing in children and adolescents with chronic pain. Although obesity has been shown to affect pain processing in adults, almost nothing is known about pediatric populations. The aim of this pilot study was to explore whether obesity alters sensory processing in adolescents with chronic pain. Participants were recruited from a chronic pain clinic (Chronic Pain (CP), n = 12 normal weight; Chronic Pain + Obesity (CPO), n = 19 overweight/obesity) and from an obesity clinic (Obesity alone (O), n = 14). The quantitative sensory testing protocol included assessments of thermal and mechanical pain thresholds and perceptual sensitization at two sites with little adiposity. The heat pain threshold at the hand was significantly higher in the CPO group than in either the CP or O groups. Mechanical pain threshold (foot) was significantly higher in the CPO group than the CP group. No differences were found on tests of perceptual sensitization. Correlations between experimental pain and clinical pain parameters were found for the CPO group, but not for the CP group. This preliminary study provides important lessons learned for subsequent, larger-scale studies of sensory processing for youth with co-occurring chronic pain and obesity.

Achieving self-management goals among low income older adults with functional limitations

Although self-management interventions can improve symptoms and disease among older adults, there is a dearth of literature on how self-management behaviors may improve factors related to the older adults' physical function. To fill this gap in the literature, we describe the patient-directed self-management goals in nursing visits that relate to physical function as part of a multi-component program. We analyze the self-management goals and outcomes of 367 low- income older adults with functional limitations who participated in the CAPABLE program: a program to reduce the health effects of impaired physical function in low-income older adults. We focus on the following self-management goals that participants chose with the nurses: pain management, depressive symptoms, incontinence, fall prevention, and communication with healthcare providers. The majority of participants chose pain (50%) or fall prevention (51%) as goals and partially or fully met their goals. Improvements across these areas may lead to improved physical function.

Exercise intervention for unilateral amputees with low back pain: study protocol for a randomised, controlled trial

Background

Atraumatic lower limb amputation is a life-changing event for approximately 185,000 persons in the United States each year. A unilateral amputation is associated with rapid changes to the musculoskeletal system including leg and back muscle atrophy, strength loss, gait asymmetries, differential mechanical joint loading and leg length discrepancies. Even with high-quality medical care and prostheses, amputees still develop secondary musculoskeletal conditions such as chronic low back pain (LBP). Resistance training interventions that focus on core stabilization, lumbar strength and dynamic stability during loading have strong potential to reduce LBP and address amputation-related changes to the musculoskeletal system. Home-based resistance exercise programs may be attractive to patients to minimize travel and financial burdens.

Methods/design

This study will be a single-assessor-blinded, pre-post-test randomised controlled trial involving 40 men and women aged 18–60 years with traumatic, unilateral transtibial amputation. Participants will be randomised to a home-based, resistance exercise group (HBRX) or a wait-list control group (CON). The HBRX will consist of 12 weeks of elastic resistance band and bodyweight training to improve core and lumbopelvic strength. Participants will be monitored via Skype or Facetime on a weekly basis. The primary outcome will be pain severity (11-point Numerical Pain Rating Scale; NRS_pain). Secondary outcomes will include pain impact on quality of life (Medical Outcomes Short Form 36, Oswestry Disability Index and Roland Morris Disability Questionnaire), kinematics and kinetics of walking gait on an instrumented treadmill, muscle morphology (muscle thickness of multifidus, transversus abdominis, internal oblique), maximal muscle strength of key lumbar and core muscles, and daily step count.

Discussion

The study findings will determine whether a HBRX program can decrease pain severity and positively impact several physiological and mechanical factors that contribute to back pain in unilateral transtibial amputees with chronic LBP. We will determine the relative contribution of the exercise-induced changes in these factors on pain responsiveness in this population.

Trial registration

ClinicalTrials.gov, ID: NCT03300375. Registered on 2 October 2017.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2362-0) contains supplementary material, which is available to authorized users.

Correlation of Body Composition and Low Back Pain Severity in a Cross-Section of US Veterans

OBJECTIVE

Back pain is more prevalent in the obese, but whether back pain severity is directly correlated to obesity in veterans is unknown. We sought to determine if there was a correlation between body composition and low back pain severity in a sample of veterans. The hypothesis was that veterans with higher body mass index values would report higher low back pain severity scores.

METHODS

This study was a retrospective chart review of 1768 veterans presenting to a Veterans Affairs chiropractic clinic with a chief complaint of low back pain between January 1, 2009 and December 31, 2014. Spearman's rho was used to test for correlation between body composition as measured by body mass index and low back pain severity as measured by the Back Bournemouth Questionnaire.

RESULTS

On average, the sample was predominantly male (91%), older than 50, and overweight (36.5%) or obese (48.9%). There was no correlation between body mass index and Back Bournemouth Questionnaire scores, r = .088, p < .001.

CONCLUSIONS

The majority of veterans with low back pain in this sample were either overweight or obese. There was no correlation between body composition and low back pain severity in this sample of veterans.

Does body mass index (BMI) influence the Ankylosing Spondylitis Disease Activity Score in axial spondyloarthritis?: Data from the SPACE cohort

Objective

Obesity is associated with elevated C reactive protein (CRP) levels. The Ankylosing Spondylitis Disease Activity Score (ASDAS) combines patient-reported outcomes (PROs) and CRP. We evaluated the effect of body mass index (BMI) on CRP and on ASDAS, and studied if ASDAS can be used in obese axial spondyloarthritis (axSpA) patients to assess disease activity.

Methods

Baseline data of patients with chronic back pain of short duration included in the SPondyloArthritis Caught Early (SPACE) cohort were used. Collected data included BMI and ASDAS. Patients were classified according to the ASAS axSpA classification criteria and BMI (overweight ≥25 and obese ≥30). Correlation and linear regression analyses were performed to assess the relation between BMI and ASDAS. Linear regression models were performed to assess if age or gender were effect modifiers in the relation between BMI and CRP, and between BMI and ASDAS.

Results

In total, 428 patients were analysed (n=168 axSpA; n=260 no-axSpA). The mean age was 31.1 years, 36.9% were male, 26.4% were overweight and 13.3% obese, median CRP was 3 mg/L and the mean ASDAS was 2.6. Gender was the only factor modifying the relationship between BMI and CRP as BMI had an influence on CRP only in females (β=0.35; p<0.001). Correlations between BMI and CRP or PROs were generally weak, and only significant for CRP in female patients. BMI was not related to ASDAS in axSpA patients.

Conclusions

ASDAS is not affected by BMI in axSpA patients. Therefore, based on our data it is not necessary to take BMI in consideration when assessing disease activity using ASDAS in axSpA patients.

Gender differences in depression and pain: A two year follow-up study of the Survey of Health, Ageing and Retirement in Europe

BACKGROUND

The longitudinal association of depression and pain according to gender was investigated using a population-based sample from 13 European countries.

METHODS

The study population was taken from waves 4-5 of the Survey of Health, Ageing and Retirement in Europe. The sample consisted of 22,280 participants ≥50 years, who were interviewed at baseline, and after two years. Regression models for each gender were used to assess the variables associated with depression and pain incidence and persistence.

RESULTS

Prevalences of depression, pain, and depression-pain co-occurrence, were higher in women than in men (depression: 34.5% vs. 20.3%; OR=2.1; 95% CI=1.9-2.2; pain: 60.2% vs. 53.5%; OR=1.3; 95% CI=1.2-1.4; co-occurrence 25.3% vs. 14.0%; OR=2.3; 95% CI=2.2-2.6). Treated baseline pain in women (OR=1.6; 95% CI=1.3-2.0), and treated/untreated pain in men (untreated OR=1.3; 95% CI=1.1-1.7; treated OR=2.0; 95% CI=1.5-2.7), were associated with incident depression. Untreated baseline depression was associated with incident pain (women OR=1.3; 95% CI=1.1-1.7; men OR=1.8; 95% CI=1.3-2.6), and with persistent pain only in women (OR=1.3; 95% CI=1.1-1.6).

LIMITATIONS

We lack information on pain severity, and the consumption of analgesics was used as a proxy. We lack information on antidepressants and anxiolytics consumption separately. Participants were interviewed twice in two years, and pain/depression at both interviews were considered persistent although they may have relapsed and recurred.

CONCLUSIONS

Treated baseline pain is a risk factor for incident depression in both genders; untreated baseline pain is a risk factor only in men. Treating depression at baseline may protect from developing pain in both genders, and in women, it may also protect from pain persistence.

Osteoarticular diseases and physical performance of Brazilians over 80 years old

Abstract Objective To investigate the physical performance of Brazilian individuals older than 80 years with and without OD. Methods The sample consisted of 135 individuals (aged > 80 years) of both gender. Identification of osteopenia/osteoporosis was verified by Dual Energy X-ray Absorptiometry, and the presence of others osteoarticular diseases (OD) was obtained using a questionnaire of morbidities. Physical performance was analyzed by motor tests. Results Men presented higher proportion of osteopenia/osteoporosis compared to women (p = 0.013). The proportion of older people with arthritis/osteoarthritis for women and men was 33% and 26%, respectively, and with OD in the spine was 19% and 12%, respectively. No significant difference for physical performance, measured by each test and overall score, was observed between groups of OD. According to gender, male with OD presented lower performance in gait speed, balance and overall score (p < 0.05), while older people with osteopenia/osteoporosis are at higher risk for low physical performance (OR 2.73; CI 95% 1.31-5.66). Conclusion In conclusion it was verified in older people with age of 80 years or more, a high prevalence of OD, especially in men, and the presence of these diseases interfered negatively their physical performance.

The Relationship Among Neuromuscular Impairments, Chronic Back Pain, and Mobility in Older Adults

BACKGROUND

For older adults with mobility problems, one focus of rehabilitation is treating the underlying neuromuscular impairment(s) that lead to functional decline and disability. Knowing which neuromuscular impairments contribute to basic mobility tasks among older adults with back pain will fill an important knowledge gap and is a critical step towards developing mechanistically based rehabilitative interventions.

OBJECTIVE

To evaluate the relationship of neuromuscular impairments with performance of mobility tasks among older adults with and without back pain.

DESIGN

Cross-sectional analysis of baseline data from the Boston Rehabilitative Impairment Study of the Elderly.

SETTING

Primary care-based population.

PATIENTS

Participants (N = 430) were older primary care patients who completed assessments of neuromuscular impairments and mobility tasks.

METHODS

Back pain was assessed by the use of an established comorbidity questionnaire. Neuromuscular impairments included trunk extensor muscle endurance, kyphosis, leg strength, leg strength asymmetry, leg speed, mean reaction time, leg coordination, and knee and ankle range of motion.

MAIN OUTCOME MEASUREMENTS

Mobility tasks included gait speed, standing balance, chair stand, and patient-reported functional status. Analysis of covariance was used to generate adjusted means for neuromuscular impairments that differed significantly by back pain status. Separate multivariable regression models evaluated the association between neuromuscular impairments and mobility based on back pain status after we adjusted for sociodemographic factors and physiologic impairments.

RESULTS

Participants had an average age of 77 years, 68% were female, and 31% reported back pain. Trunk extensor muscle endurance, leg strength, and rapid leg coordination were significantly lower among those with back pain compared to those without (P < .01, P = .01, P = .04, respectively). Patterns of neuromuscular impairments that were associated with mobility tasks differed according to back pain status.

CONCLUSIONS

The neuromuscular impairment profiles associated with mobility function among older adults with back pain vary compared with older adults without back pain.

Gait analysis methods for rodent models of osteoarthritis

Patients with osteoarthritis (OA) primarily seek treatment due to pain and disability, yet the primary endpoints for rodent OA models tend to be histological measures of joint destruction. The discrepancy between clinical and preclinical evaluations is problematic, given that radiographic evidence of OA in humans does not always correlate to the severity of patient-reported symptoms. Recent advances in behavioral analyses have provided new methods to evaluate disease sequelae in rodents. Of particular relevance to rodent OA models are methods to assess rodent gait. While obvious differences exist between quadrupedal and bipedal gait sequences, the gait abnormalities seen in humans and in rodent OA models reflect similar compensatory behaviors that protect an injured limb from loading. The purpose of this review is to describe these compensations and current methods used to assess rodent gait characteristics, while detailing important considerations for the selection of gait analysis methods in rodent OA models.

Chronic pain management in the obese patient: a focused review of key challenges and potential exercise solutions

In obese persons, general and specific musculoskeletal pain is common. Emerging evidence suggests that obesity modulates pain via several mechanisms such as mechanical loading, inflammation, and psychological status. Pain in obesity contributes to deterioration of physical ability, health-related quality of life, and functional dependence. We present the accumulating evidence showing the interrelationships of mechanical stress, inflammation, and psychological characteristics on pain. While acute exercise may transiently exacerbate pain symptoms, regular participation in exercise can lower pain severity or prevalence. Aerobic exercise, resistance exercise, or multimodal exercise programs (combination of the two types) can reduce joint pain in young and older obese adults in the range of 14%-71.4% depending on the study design and intervention used. While published attrition rates with regular exercise are high (∼50%), adherence to exercise may be enhanced with modification to exercise including the accumulation of several exercise bouts rather than one long session, reducing joint range of motion, and replacing impact with nonimpact activity. This field would benefit from rigorous comparative efficacy studies of exercise intensity, frequency, and mode on specific and general musculoskeletal pain in young and older obese persons.

Obesity in older persons

PURPOSE OF REVIEW

There is an increasing number of reports suggesting that indicators of obesity for the general adult population may need to be modified; that the magnitude of risk is attenuated or that adiposity may even be protective; and that additional adverse outcomes specific to older persons need to be considered. Finally, there are benefits and adverse effects of weight loss programmes for older persons. This article reviews publications addressing these issues from 2013 to March 2014.

RECENT FINDINGS

BMI was not considered to be as good an indicator of obesity because of loss of muscle mass with age. Higher body weight seems to be protective among older persons with chronic diseases or geriatric syndromes. Increased adiposity together with decreased muscle mass (sarcopenic obesity) is associated with adverse outcomes, although there is no consensus regarding the definition. Intentional weight loss has health benefits but is accompanied by muscle and bone loss, and therefore programmes should include components to counteract these changes.

SUMMARY

The magnitude of health risk associated with obesity is attenuated with age, and mild increase in adiposity may be beneficial for those who are frail and/or with chronic diseases. Weight loss programmes should include resistance exercises to counteract muscle loss.

The influence of body mass index on survival in breast cancer patients

INTRODUCTION

More than half of breast cancer survivors (BCSs) are obese at diagnosis and experience approximately 50% to 96% of weight gain during treatment that could physically affect their survival. The aim of the study was to evaluate the influence of body mass index (BMI) on physical, anthropometric, and physiological parameters in BCSs.

PATIENTS AND METHODS

A cross-sectional study was conducted with 147 BCSs. Health-related fitness, anthropometric measures, cardiovascular state, and cancer-related fatigue (CRF) were assessed for our analysis and 3 groups were formed.

RESULTS

Tests of force handgrip (affected side: F = 3.44; P < .05; nonaffected side: F = 3.067; P < .05), functional capacity (F = 3.239; P = .043), and endurance of trunk flexors (×2 = 8.264; P = .016) were significantly lower in obese BCSs compared with the normal-weight group, whereas systolic (F = 5.839; P = .004) and diastolic blood pressure (F = 8.794; P < .001), waist circumference (F = 85.81; P < .001), and arm circumference at 10 cm (affected side: F = 23.530; P < .001; nonaffected side: F = 17.095; P < .001) and 5 cm (affected side: F = 21.751; P < .001; nonaffected side: F = 22.490; P < .001) were significantly greater in BCSs with higher BMI compared with other groups. No significant differences were observed between groups regarding lower limb endurance, resting heart rate or CRF.

CONCLUSION

This study demonstrated the influence of obesity on health-related fitness, anthropometric measures, and cardiovascular state.