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      Multi-site Pain Is Associated with Long-term Patient-Reported Outcomes in Older Adults with Persistent Back Pain

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          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.

          Related collections

          Most cited references29

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          Report of the NIH Task Force on research standards for chronic low back pain.

          Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades. We often cannot identify mechanisms to explain the major negative impact cLBP has on patients' lives. Such cLBP is often termed non-specific and may be due to multiple biologic and behavioral etiologies. Researchers use varied inclusion criteria, definitions, baseline assessments, and outcome measures, which impede comparisons and consensus. Therefore, NIH Pain Consortium charged a Research Task Force (RTF) to draft standards for research on cLBP. The resulting multidisciplinary panel recommended using 2 questions to define cLBP; classifying cLBP by its impact (defined by pain intensity, pain interference, and physical function); use of a minimum dataset to describe research participants (drawing heavily on the PROMIS methodology); reporting "responder analyses" in addition to mean outcome scores; and suggestions for future research and dissemination. The Pain Consortium has approved the recommendations, which investigators should incorporate into NIH grant proposals. The RTF believes that these recommendations will advance the field, help to resolve controversies, and facilitate future research addressing the genomic, neurologic, and other mechanistic substrates of chronic low back pain. We expect that the RTF recommendations will become a dynamic document and undergo continual improvement.
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            A national catalog of preference-based scores for chronic conditions in the United States.

            The variability in preferences used in quality-adjusted life-years estimation jeopardizes the comparability of cost-effectiveness analyses and has led the Panel on Cost-Effectiveness in Health and Medicine (the PCEHM) to call for a catalog of "off-the-shelf" preference weights associated with conditions that can be used by health researchers without the burden of collecting primary data. The current research responds to the call by developing a nationally representative catalog of preference-based scores for chronic conditions and associated sociodemographic characteristics. The authors report the EQ-5Dindex scores of chronic conditions and associated sociodemographic characteristics in the nationally representative Medical Expenditure Panel Survey (MEPS). Chronic conditions were coded using "quality priority conditions" (QPC) and clinical classification categories (CCC). OLS, Tobit, and censored least absolute deviations (CLAD) regression models were used to provide condition estimates adjusted for age, comorbidity, gender, race, ethnicity, income, and education. Unadjusted and adjusted EQ-5Dindex scores for each QPC and CCC code are presented. EQ-5Dindex scores for older age categories were lower than younger categories, female scores were lower than males, certain racial groups had lower scores than others, and EQ-5Dindex scores were higher for individuals with higher education and income levels. The preference-based chronic condition scores reported in this research are nationally representative and may be useful to researchers to calculate quality-adjusted life-years for cost-effectiveness analyses and population-based burden of illness studies without the difficulty of primary data collection. Further research is necessary to validate these scores in condition-specific studies.
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              Comorbid subjective health complaints in low back pain.

              Cross-sectional study. To compare subjective health complaints in subacute patients with low back pain with reference values from a Norwegian normal population. Comorbidity is common with nonspecific low back pain. We wanted to investigate if these complaints were specific or part of a more general unspecific condition comparable to subjective health complaints in the normal population. The study group consisted of 457 patients sick-listed 8 to 12 weeks for low back pain. All subjects filled out questionnaires. The subjective health complaints in the study group were compared with reference values from a Norwegian normal population using logistic regression analysis. Compared with the normal reference population, the patients with low back pain had significantly more low back pain, neck pain, upper back pain, pain in the feet during exercise, headache, migraine, sleep problems, flushes/heat sensations, anxiety, and sadness/depression. The prevalence of pain in arms, pain in shoulders, and tiredness was also high, but not significantly higher than in the reference population. Our findings indicate that patients with low back pain suffer from what may be referred to as a "syndrome," consisting of muscle pain located to the whole spine as well as to legs and head, and accompanying sleep problems, anxiety, and sadness/depression.
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                Author and article information

                Journal
                Pain Medicine
                Oxford University Press (OUP)
                1526-2375
                1526-4637
                October 2019
                October 01 2019
                January 05 2019
                October 2019
                October 01 2019
                January 05 2019
                : 20
                : 10
                : 1898-1906
                Affiliations
                [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
                Article
                10.1093/pm/pny270
                30615144
                5ec235df-6f3b-4fb3-8d0a-ceba6b4ec11f
                © 2019

                https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model

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