Biopsychosocial Profiles and Functional Correlates in Older Adults with Chronic Low Back Pain: A Preliminary Study.

Objective To describe key peripheral and central nervous system (CNS) conditions in a group of older adults with chronic low back pain (CLBP) and their association with pain severity and self-reported and performance-based physical function. Design Cross-sectional. Setting Outpatient VA clinics. Subjects Forty-seven community-dwelling veterans with CLBP (age 68.0 ± 6.5 years, range = 60-88 years, 12.8% female, 66% white) participated. Methods Data were collected on peripheral pain generators-body mass index, American College of Rheumatology hip osteoarthritis criteria, neurogenic claudication (i.e., spinal stenosis), sacroiliac joint (SIJ) pain, myofascial pain, leg length discrepancy (LLD), and iliotibial band pain; and CNS pain generators-anxiety (GAD-7), depression (PHQ-9), insomnia (Insomnia Severity Index), maladaptive coping (Fear Avoidance Beliefs Questionnaire, Cognitive Strategies Questionnaire), and fibromyalgia (fibromyalgia survey). Outcomes were pain severity (0 to 10 scale, seven-day average and worst), self-reported pain interference (Roland Morris [RM] questionnaire), and gait speed. Results Approximately 96% had at least one peripheral CLBP contributor, 83% had at least one CNS contributor, and 80.9% had both peripheral and CNS contributors. Of the peripheral conditions, only SIJ pain and LLD were associated with outcomes. All of the CNS conditions and SIJ pain were related to RM score. Only depression/anxiety and LLD were associated with gait speed. Conclusions In this sample of older veterans, CLBP was a multifaceted condition. Both CNS and peripheral conditions were associated with self-reported and performance-based function. Additional investigation is required to determine the impact of treating these conditions on patient outcomes and health care utilization.

目的 描述一组患有慢性下腰痛（CLBP）的老年人的主要外周和中枢神经系统（CNS）状况，以及它们与疼痛严重程度、自我报告的和基于表现的身体功能之间的关联。 设计 横断面研究。 地点 退伍军人事务部（VA）门诊诊所。 研究对象 47名患有CLBP的社区居住退伍军人参与研究（年龄68.0 ± 6.5岁，范围为60 - 88岁，女性占12.8%，白人占66%）。 方法 收集有关外周疼痛产生因素的数据——体重指数、美国风湿病学会髋关节骨关节炎标准、神经源性跛行（即椎管狭窄）、骶髂关节（SIJ）疼痛、肌筋膜疼痛、腿长差异（LLD）和髂胫束疼痛；以及中枢神经系统疼痛产生因素——焦虑（广泛性焦虑障碍量表 - 7，GAD - 7）、抑郁（患者健康问卷 - 9，PHQ - 9）、失眠（失眠严重程度指数）、适应不良的应对方式（恐惧回避信念问卷、认知策略问卷）和纤维肌痛（纤维肌痛调查）。结果指标为疼痛严重程度（0 - 10分量表，7天平均值和最差值）、自我报告的疼痛干扰（罗兰·莫里斯[RM]问卷）和步速。 结果 约96%的人至少有一个外周CLBP影响因素，83%的人至少有一个中枢神经系统影响因素，80.9%的人同时有外周和中枢神经系统影响因素。在外周状况中，只有SIJ疼痛和LLD与结果相关。所有中枢神经系统状况和SIJ疼痛都与RM评分相关。只有抑郁/焦虑和LLD与步速相关。 结论 在这个老年退伍军人样本中，CLBP是一种多方面的疾病。中枢神经系统和外周状况都与自我报告的和基于表现的功能相关。需要进一步研究以确定治疗这些状况对患者结果和医疗保健利用的影响。