Back pain can be very disabling on a daily basis, in the elderly, it can lead to loss of autonomy and death, underlines this study from the Boston Medical Center. Younger people will be embarrassed but struggle to perform daily activities, but older people may want to avoid them for fear of pain or worsening symptoms. This daily incapacity promotes a sedentary lifestyle and isolation, weight gain and the development or progression of various chronic diseases. With a significantly increased risk of premature death, according to these data presented in the Journal of General Internal Medicine.
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This study is the first to measure the impact of chronic back pain on mortality. The message from these Boston researchers is clear: half of the effects of persistent back pain in older women is explained by disability and the progressive loss of autonomy in everyday life. Consequences probably similar to those of other joint and muscle pain that can reduce the autonomy and mobility of the elderly patient.
Persistent and frequent back pain is associated with premature death: the demonstration is made on a cohort of 8,321 elderly women, followed on average for 14 years. The researchers assessed the back pain of the participants at inclusion and then 2 years later. During the 4th year of follow-up, participants were asked about common activities of daily living. The analysis reveals that the disability associated with the severity of back pain largely explains the association with mortality. More precisely,
- difficulty performing one or more basic daily activities, such as walking short distances or preparing a meal, explains almost half (47%) of the effects of chronic low back pain on mortality;
- slow performance on more objective measures, such as observed walking speed or repetitive "lifting" of a chair, still explains around a quarter of this association (27% and 24%, respectively);
- of all participants, 56% died after a median follow-up of 14.1 years. A higher proportion of women with persistent and frequent back pain died (65.8%) vs participants without back pain (53.5%).
- After accounting for possible confounders, in these older women, persistent and frequent back pain is associated with a 24% increased risk of death vs no back pain.
Disability and incapacity explain the majority of the effects of chronic back pain on the risk of death in the elderly patient. Back pain is the leading cause of disability worldwide and women between the ages of 40 and 80 have the highest prevalence of back pain. In epidemiological studies, women report more frequent and severe back pain than men. The study is the first to show a link between the degree of disability related to back pain and mortality.
Could better management of back pain prevent disability , improve quality of life and prolong life? Lead author Dr. Eric Roseen raises the question. Studies of the long-term impact of back pain treatments and low back pain self-care strategies need to be conducted.
But already there is a call for clinicians to systematically assess the physical function of older people with back pain and guideline-based back pain management through minimally invasive treatments.
