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, which was 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, the Patient-Reported Outcomes Measurement Information System (PROMIS)-29, medical comorbidity, pain medications, the Medical Outcomes Study social support scale, the Prescribed Opioids Difficulties Scale, and the Pain Self-Efficacy Questionnaire. No disability to minimal disability was defined as ODI ≤ 20, moderate disability as 20 < ODI ≤ 40, and severe to crippling disability as ODI > 40, to which we fitted a multinomial logistic regression model with a generalized logit link and forward selection.

Results: Participants' average age was 73.5 years, 93% were male, 67% were white, and 28% were black. Approximately 24% reported no disability to mild disability, 50% moderate disability, and 26% severe to crippling disability. Among the 3 modifiable risk factors identified, for each 5-point increase in self-efficacy, there was an ∼50% lower risk of moderate disability (OR 0.54 [0.42-0.69]; P < .0001) and an ∼60% lower risk of severe/crippling disability (OR 0.39 [0.29-0.52]; P < .0001). Difficulty falling asleep was associated with more than double the risk of moderate disability (OR 2.48 [1.06-5.81]; P = .0367) and a nearly 6-fold greater risk of severe/crippling disability (OR 5.77 [2.09-15.96]); P = .0007). Each 1-point increase in pain severity was associated with an ∼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.