Correlates of pain-related disability in older veterans with chronic low back pain

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.

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.

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.

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