Back complaints in older adults

With the aging of the Dutch population, the number of older aged back pain patients is also expected to increase. However, information on the course and prognosis of older patients with back pain in general practice is very scarce. Back pain is a common musculoskeletal disorder, also in older adults, information about back pain in older adults is therefore important. In addition, because there are several important reasons why back pain in older adults might differ from back pain in the younger adult population, information about younger back pain patients may not be generalizable to older adults. The overall objective of the studies presented in this thesis are therefore to acquire information about back pain in older adults and more specific to gain insight into: 1) the course of back pain in older adults in general practice, 2) the characteristics of these patients and their back pain, 3) prognostic factors for poor recovery of older adults with back pain, 4) the association between perceived lumbar stiffness and lumbar disc degeneration (LDD) as assessed on X-ray, and 5) the medical consumption of back pain patients

Back Complaints in the Elders (BACE); design of cohort studies in primary care: an international consortium

Background: Although back complaints are common among older people, limited information is available in the literature about the clinical course of back pain in older people and the identification of older persons at risk for the transition from acute back complaints to chronic back pain. The aim of this study is to assess the course of back complaints and identify prognostic factors for the transition from acute back complaints to chronic back complaints in older people who visit a primary health care physician. Methods/design. The design is a prospective cohort study with one-year follow-up. There will be no interference with usual care. Patients older than 55 years who consult a primary health care physician with a new episode of back complaints will be included in this study. Data will be collected using a questionnaire, physical examination and X-ray at baseline, and follow-up questionnaires afte

Course of back complaints in older adults: a systematic literature review

BACKGROUND: Back pain is a common musculoskeletal complaint seen in older people. It is important to get an insight in the course of back complaints and to identify factors associated with a chronic course. AIM: To describe the course of acute and subacute back complaints in older people (≥ 45 years) and to identify prognostic factors for developing chronic back complaints. DESIGN: Systematic review of the literature. METHODS: A database search was conducted in MEDLINE, EMBASE, Cochrane library, CINAHL, PsycINFO and PEDro. Cohort studies or randomized controlled trials reporting on the course of acute or subacute back complaints in older people were included. The percentage of patients that developed chronic back complaints was calculated, if possible. RESULTS: The search yielded 9293 potentially relevant articles. Of these, 5 studies met all inclusion criteria. At 3 months follow-up 37-40% of the patients still had back complaints. At 12 months follow-up, the percen

Natural History of Back Pain in Older Adults over Five Years

INTRODUCTION: Back pain is a prevalent health problem. Research often focuses on adults. Evidence on the long-term course of back pain in older patients is limited. A prospective cohort study (BACE) was conducted in a primary care setting in the Netherlands. We aim to investigate the 5-year course and medical consumption of older adults (>55 years) presenting with back pain in general practice. METHODS: Patients aged >55 years, consulting their general practitioner with a new back pain episode, were included between 2009 to 2011. Follow-up questionnaires included, for example, pain severity, disability, quality of life, recovery, and medical consumption. RESULTS: A total of 675 patients (mean age ± SD, 66.4 ± 7.6 years) participated, showing a mean (± SD) back pain reduction from 5.2 (± 2.7) to 3.6 (± 2.8) (numeric rating scale, 0 to 10) at 3 months follow-up; disability decreased from 9.8 (± 5.8) to 7.8 (± 6.2) (Roland-Morris Disability Questionnaire, 0 to 24). After 6 months, this remained practically constant over time. Medical consumption was highest in the first months; medication was used by 72% at baseline and approximately one-third (25% to 39%) during follow-up. At 5-year follow-up (response rate 58%; n = 392), 43% had recovered; a majority reported persistent or recurrent back pain. CONCLUSION: Clinically relevant improvements in back pain intensity and disability were seen in the first 3 to 6 months of follow-up. A majority of patients does not become pain free within 3 months; this does not improve over 5 years. However, most patients stop consulting health care professionals during follow-up. Current medical strategies may not be sufficient in older back pain patients, where back pain becomes a recurrent or chronic condition in the majority of patients

Back Complaints in Older Adults:Prevalence of Neuropathic Pain and Its Characteristics

<p>ObjectiveNeuropathic symptoms are reported in 16-55.6% of patients with back pain. Studies were performed in various populations; however, none focused on older adults. The aim of the study was to assess prevalence of neuropathic pain in older adults with back pain.</p><p>MethodsPrevalence of neuropathic pain, measured with the Dolour Neuropathique en 4 questions (DN4), was assessed in the Back Complaints in the Elders study (Netherlands). Patients (>55 years) consulting their general practitioner with a new episode of back complaints were included. Two DN4-versions were used: one based on interview plus physical examination, the other based on interview alone. In the interview plus physical examination version, patients' and complaint characteristics were compared between groups with different scores (0, 1, 2, 3, and 4). The DN4 interview-version compared patients with negative and positive scores.</p><p>ResultsOf the 261 included patients available for analysis were 250 patients (95.8%) with the DN4 interview plus physical examination, and 259 patients (99.2%) with the DN4 interview. In DN4 interview plus physical examination (N=250), five patients (2%) scored positive (score 4). Higher score was associated with pain radiating below the knee (P</p><p>ConclusionsIn older adults with back pain presenting with a new episode in primary care, prevalence of neuropathic pain is low and seems to be associated with pain radiating below the knee, use of paracetamol, and higher body mass index.</p>

Prevalence and “red flags” regarding specified causes of back pain in older adults presenting in general practice

Background. In a small proportion of patients experiencing unspecified back pain, a specified underlying pathology is present. Objective. The purposes of this study were: (1) to identify the prevalence of physician specified causes of back pain and (2) to assess associations between “red flags” and vertebral fractures, as diagnosed by the patients’ general practitioner (GP), in older adults with back pain. Methods. The Back Complaints in the Elders (BACE) study is a prospective cohort study. Patients (aged >55 years) with back pain were included when consulting their GP. A questionnaire was administered and a physical examination and heel bone densitometry were performed, and the results determined back pain and patient characteristics, including red flags. Participants received a radiograph, and reports were sent to their GP. The final diagnoses established at 1 year were collected from the GP’s patient registry. Results. Of the 669 participants included, 6% were diagnosed with a serious underlying pathology during the 1-year follow-up. Most of these participants (n=33, 5%) were diagnosed with a vertebral fracture. Multivariable regression analysis showed that age of ≥ 75 years, trauma, osteoporosis, a back pain intensity score of ≥ 7, and thoracic pain were associated with a higher chance of getting the diagnosis of a vertebral fracture. Of these variables, trauma showed the highest positive predictive value for vertebral fracture of 0.25 (95% confidence interval=0.09, 0.41) and a positive likelihood ratio of 6.2 (95% confidence interval=2.8, 13.5). A diagnostic prediction model including the 5 red flags did not increase these values. Limitations. Low prevalence of vertebral fractures could have led to findings by chance. Conclusions. In these older adults with back pain presenting in general practice, 6% were diagnosed with serious pathology, mainly a vertebral fracture (5%). Four red flags were associated with the presence of vertebral fracture