Correlates of Pain-Related Disability in Older Veterans with Chronic Low Back Pain.

Abstract

Background: Chronic low back pain (CLBP) is a potentially disabling condition that affects an estimated one-third of older adults. Treatments recommended by existing guidelines result in modest improvements. Identification of modifiable factors that contribute to CLBP-associated disability in older adults is needed to optimize outcomes.

Methods: Baseline data were analyzed from 275 participants in the Aging Back Clinics trial designed to evaluate the efficacy of a personalized approach to treating CLBP in older Veterans. Participants had low back pain of moderate severity on half the days for 6 months or worse, a negative dementia screen, no red flags or history of lumbar surgery, and no communication impairment. Measures included demographics, the Oswestry Disability Index (ODI-main outcome), the NIH Minimal Data Set for CLBP research, PROMIS-29, medical comorbidity, pain medications, Medical Outcomes Study social support scale, Prescribed Opioids Difficulties Scale, and the Pain Self-Efficacy Questionnaire. No to minimal disability was defined as ODI ≤ 20, moderate as 20 40 to which we fitted multinomial logistic regression model with a generalized logit link and forward selection.

Results: Average age was 73.5, 93% were male, 67% white and 28% black. Approximately 24% reported no-mild, 50% moderate and 26% severe-crippling disability. Among the three modifiable risk factors identified, for each 5-point increase in self-efficacy, there was ∼ 50% lower risk of moderate (OR 0.54 [0.42-0.69]; p < 0.0001) and ∼60% lower risk of severe/crippling disability (OR 0.39 [0.29-0.52]; p < 0.0001). Difficulty falling asleep was associated with over doubling risk of moderate disability (OR 2.48 [1.06-5.81]; p = 0.0367) and nearly sixfold greater risk of severe/crippling disability (OR 5.77 [2.09-15.96]); p = 0.0007). Each one-point increase in pain severity was associated with a ∼1.5-fold increased risk of moderate and severe disability.

Conclusions: Low self-efficacy, difficulty falling asleep and pain severity were identified as independent and potentially modifiable factors associated with CLBP-associated disability risk.