Rachael Docking

The prevalence and management of low back pain across adulthood: results from a population-based cross-sectional study (the MUSICIAN study)

Summary Amongst the oldest old, severe back pain (but not back pain overall) is most common, and primary care consultation is more likely to result in pharmacological‐only management. ABSTRACT The aim of the current study was to determine: the prevalence of low back pain (LBP) and associated disability; the frequency of consultation to general practice; whether there were differences in management by age. We conducted a cross‐sectional population study in Aberdeen city and Cheshire County, UK. Participants were 15,272 persons aged 25 years and older. The 1‐month period prevalence of LBP was 28.5%. It peaked at age 41–50 years, but at ages over 80 years was reported by 1 in 4 persons. Older persons were more likely to consult, and the prevalence of severe LBP continued to increase with age. Management by general practitioners differed by age of the patient. Older persons (>70 vs ⩽40 years) were more likely to only have been prescribed painkillers (odds ratio [OR] 1.74, 95% confidence interval [CI] 1.28–2.35) or only pain killers with other medications (OR 1.45, 95% CI 1.07–1.98). They were less likely to be prescribed physiotherapy or exercise (OR 0.63, 95% CI 0.46–0.85) or to be referred to a specialist (OR 0.77, 95% CI 0.57–1.04). Older persons were more likely to have previously received exercise therapy for pain, were less likely to be enthusiastic about receiving it now (P < 0.0001), and were less likely to think it would result in improved symptoms (P < 0.0001). It is important that older persons, who have the highest prevalence of LBP with disability and are most likely to consult, are receiving optimal pharmacological and nonpharmacological management.

Epidemiology of back pain in older adults: prevalence and risk factors for back pain onset

OBJECTIVES To determine the prevalence of disabling and non-disabling back pain across age in older adults, and identify risk factors for back pain onset in this age group. METHODS Participants aged ≥ 75 years answered interviewer-administered questions on back pain as part of a prospective cohort study [Cambridge City over-75s Cohort Study (CC75C)]. Descriptive analyses of data from two surveys, 1988-89 and 1992-93, estimated prevalence and new onset of back pain. Relative risks (RRs) and 95% CIs were estimated using Poisson regression, adjusted for age and gender. RESULTS Prevalence of disabling and non-disabling back pain was 6 and 23%, respectively. While prevalence of non-disabling back pain did not vary significantly across age (χ²trend : 0.90; P = 0.34), the prevalence of disabling back pain increased with age (χ²trend : 4.02; P = 0.04). New-onset disabling and non-disabling back pain at follow-up was 15 and 5%, respectively. Risk factors found to predict back pain onset at follow-up were: poor self-rated health (RR 3.8; 95% CI 1.8, 8.0); depressive symptoms (RR 2.2; 95% CI 1.3, 3.7); use of health or social services (RR 1.7; 95% CI 1.1, 2.7); and previous back pain (RR 2.1; 95% CI 1.2-3.5). From these, poor self-rated health, previous back pain and depressive symptoms were found to be independent predictors of pain onset. Markers of social networks were not associated with the reporting of back pain onset. Conclusion. The risk of disabling back pain rises in older age. Older adults with poor self-rated health, depressive symptoms, increased use of health and social services and a previous episode of back pain are at greater risk of reporting future back pain onset.

Advanced multi-targeted composite biomaterial dressing for pain and infection control in chronic leg ulcers

This study aimed to develop advanced biomaterial polysaccharide based dressings to manage pain associated with infected chronic leg ulcers in older adults. Composite carrageenan (CARR) and hyaluronic acid (HA) dressings loaded with lidocaine (LID) and AgNPs were formulated as freeze-dried wafers and functionally characterized for porous microstructure (morphology), mechanical strength, moisture handling properties, swelling, adhesion and LID release. Antimicrobial activity of AgNPs was evaluated (turbidity assay) against Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus whilst cell viability studies (MTT) was performed on normal adult human primary epidermal keratinocyte cells. The wafers were soft, flexible and elegant in appearance. HA affected the wafer structure by increasing the resistance to compression but still possessed a balance between toughness and flexibility to withstand normal stresses and prevent damage to newly formed skin tissue respectively. Water uptake was influenced by HA, whilst equilibrium water content and LID release were similar for all the formulations, showing controlled release up to 6h. AgNPs loaded CARR/HA wafers were effective in inhibiting the growth of both Gram positive and Gram negative bacteria. MTT assay showed evidence that the AgNPs/LID loaded wafers did not interfere with cell viability and growth. CARR/HA wafers seem to be a promising system to simultaneously deliver LID and AgNPs, directly to infected chronic leg ulcers.

The relationship between back pain and mortality in older adults varies with disability and gender: Results from the Cambridge City over-75s Cohort (CC75C) study

This study aims to determine whether older adults reporting back pain (BP) are at increased risk of premature mortality, specifically, to examine the association with disabling/non‐disabling pain separately.

The epidemiology of regional and widespread musculoskeletal pain in rural versus urban settings in those ≥55 years

Objectives: To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rurality and to determine the characteristics of persons in rural locations in whom pain is found to be in excess. Methods: Participants, aged ≥55 years, from participating general practices in seven different geographical locations in Scotland were sent a postal questionnaire. The 1-month prevalence of 10 regional pain conditions plus CWP was identified using body manikins. Differences in the prevalence of pain with differing rurality were examined using Chi2 test for trend. Thereafter, among the rural population, the relationships between pain and putative risk factors were examined using Poisson regression. Thus, results are described as risk ratios. Results: There was some evidence to suggest that the prevalence of CWP increased with increasing rurality, although the magnitude of this was slight. No large or significant differences were observed with any regional pain conditions. Factors associated with the reporting of CWP included poor general health, feeling downhearted most of the time and selected measures of social contact. Factors independently associated with CWP included female gender (risk ratio: 1.24; 95% confidence interval (CI): 0.997–1.55), poor self-rated health (risk ratio: 3.50; 95% CI: 1.92–6.39) and low mood (risk ratio: 1.54; 95% CI: 1.07–2.20). Also, having fewer than 10 people to turn to in a crisis was associated with a decrease in the risk of CWP – risk ratio: 0.68 (95% CI: 0.50–0.93) and 0.78 (95% CI: 0.60–1.02) for those with 5–10 and <5 people, respectively. Conclusions: This study provides no evidence that the prevalence of regional musculoskeletal pain is increased in rural settings, although there is some evidence of a modest increase in CWP. Risk factors for CWP are similar to those seen in the urban setting, including markers of general health, mental health and also aspects of social contact. It may be, however, that social networks are more difficult to maintain in rural settings, and clinicians should be aware of the negative effect of perceived social isolation on pain in rural areas.

Usability Testing of the iPhone App to Improve Pain Assessment for Older Adults with Cognitive Impairment (Prehospital Setting): A Qualitative Study

Objectives Pain assessment in older adults with cognitive impairment is often challenging, and paramedics are not given sufficient tools/training to assess pain. The development of a mobile app may improve pain assessment and management in this vulnerable population. We conducted usability testing of a newly developed iPhone pain assessment application with potential users, in this case as a tool for clinical paramedic practice to improve pain assessment of older adults with cognitive impairment. Methods We conducted usability testing with paramedic students and a Delphi panel of qualified paramedics. Participants studied the app and paper-based algorithm from which the app was developed. The potential use for the app was discussed. Usability testing focus groups were recorded, transcribed verbatim, and analyzed using a thematic approach. Proposed recommendations were disseminated to the Delphi panel that reviewed and confirmed them. Results Twenty-four paramedic students from two UK ambulance services participated in the focus groups. Usability of the app and its potential were viewed positively. Four major themes were identified: 1) overall opinion of the app for use in paramedic services; 2) incorporating technological applications into the health care setting; 3) improving knowledge and governance; and 4) alternative uses for the app. Subthemes were identified and are presented. Discussion Our results indicate that the pain assessment app constitutes a potentially useful tool in the prehospital setting. By providing access to a tool specifically developed to help identify/assess pain in a user-friendly format, paramedics are likely to have increased knowledge and confidence in assessing pain in patients with dementia.

Pain reporting in older adults: the influence of cognitive impairment - results from the Cambridge City >75 Cohort study

Objectives: Evidence suggests that while disabling back pain (BP), and rheumatic diseases associated with pain, continues to increase with age, the prevalence of non-disabling BP reaches a plateau, or even decreases, in the oldest old. This study aimed to determine whether this age-related pattern of non-disabling BP is a function of increasing cognitive impairment. Methods: Cross-sectional study of adults aged >77 years. Participants answered interviewer-administered questions on BP and cognitive function, assessed using the Mini-Mental State Examination, categorised into normal versus mild, moderate or severe impairment. The relationship between cognitive function and BP was examined using multinomial logistic regression, adjusted for age, sex and residence. Results: Of 1174 participants with BP data, 1126 (96%) completed cognitive assessments. The relationship between cognitive function and BP differed for disabling and non-disabling BP. Across categories of cognitive impairment, increasingly higher prevalence of disabling BP was reported, compared to those with normal cognition, although this was not statistically significant (odds ratio (OR) = 1.7; 95% confidence interval (CI) = 0.7–4.6). No association was found between cognitive function and non-disabling BP (OR = 0.8; 95% CI = 0.4–1.6). Conclusion: This study found no association between the reporting of BP and level of cognitive impairment, suggesting that increasing cognitive impairment is an inadequate explanation for age-related decline in self-reported non-disabling BP. Future research should determine the reasons for the decline in non-disabling pain in older adults, although, meanwhile, it is important to ensure that this group receive appropriate pain assessment and pain management. Key points Prevalence of non-disabling back pain decreases in the oldest old. Some have proposed that this may be a function of cognitive impairment in older age, and an increasing inability to adequately report pain. Our findings do not support this hypothesis.

Attitudinal & Knowledge Barriers Towards Effective Pain Assessment & Management in Dementia: A Narrative Synthesis

Under-assessment and inadequate treatment of pain is a common problem for older adults, particularly those with dementia. This may be in part attributed to knowledge deficits and negative attitudes among healthcare staff and informal caregivers towards pain, its assessment and its management in dementia. Knowledge and attitudes have a significant predictive relationship with behavior, potentially impacting pain assessment and management practices. Despite this there remains a paucity of research in the area and a lack of clarity about existing knowledge levels and attitudes among dementia caregivers. Therefore, the aims of this review were to: identify what knowledge deficits and attitudinal barriers exist amongst dementia caregivers; and identify the scales available to measure these. A search was carried out in the following electronic databases: Academic Search Premier; CINAHL; Education Research Complete; Humanities International Journals; Psychology and Behavioral Sciences Collection; PsychINFO; PsychArticles; Teacher Reference Center; and MEDLINE. A total of 13 articles met the inclusion criteria. A number of knowledge deficits and negative attitudes were identified, particularly in the use self-reports and pain assessment tools in dementia, and the safety of opioids. Understanding and positive attitudes were demonstrated in some areas, such as non-narcotic pain medications and identifying behavioral pain indicators. Of the 4 scales identified, positive results were found for internal consistency and content validity, however further refinement and testing is necessary. It was concluded attitudinal and knowledge barriers exist which should be addressed given their influence over practice behavior, however, there is a willingness and knowledge base from which progress can build.

Role of Emerging Technologies in Geriatric Pain Management

This article provides a brief overview of the challenges and opportunities of new technologies in the area of geriatric pain management. It also reviews emerging evidence to demonstrate the role technology may play in improving and advancing assessment and management of pain in older adults.

AB1128 An Evaluation of A Comic Book for Children Explaining Chronic Pain in Older Adults: A Qualitative Study of Older People's Views on the Value of “Medikidz Explain Pain”

Background Chronic pain is a particular problem for older adults: age-related biopsychosocial changes can make it more difficult to deal with the effects of chronic pain, and widely held views that living with pain is a natural consequence of aging can add to the problem. For many older people their role as a grandparent is a significant part of their life and this can be disrupted by chronic pain. As part of a large study on self management by older people with chronic pain (EOPIC) we developed a comic book to address an issue that older people highlighted as important to them: a lack of understanding by their grandchildren and other family members of how pain affects the older person. The comic book, “Whats Up With Moiras Grandad? Medikidz Explain Chronic Pain”, presents key information, including that gathered within the EOPIC study from interviews with older people about their experience of living with pain. The book was developed in partnership with Medikidz, in their specialist format of comic books of health information for children and younger people. Objectives To explore older peoples views on the value of the comic book. Methods This is a qualitative study using semistructured interviews. Participants were older people over 65 years with self-reported chronic pain, living in the community, who were grandparents. Purposive sampling was used to recruit men and women from a range of ages. Participants were given a copy of the comic book to use at their discretion. They then took part in a face to face interview during which they discussed their thoughts on the value of the book in the context of their role as a grandparent. The interviews were audio recorded and transcribed. The transcripts were analysed thematically. Results 13 people have been interviewed (6 women, 7 men; age range 63-87; range of duration of living with pain 3-30 years). Discussions described various degrees of disruptive effects of chronic pain on grandparenting, and understanding by young people and other family members of older people with chronic pain. Most participants were very positive about the potential of the book to facilitate young peoples understanding about chronic pain and its effects in older people, highlighting issues including the attractiveness of the format, the authenticity of the story, and the comprehensive scope of the information. Conclusions The comic book is a potentially useful resource to facilitate the understanding of younger people, and the wider family, about how chronic pain affects older adults. Acknowledgements The study was supported by a grant from the Joint UK Research Council Lifelong Health and Wellbeing initiative. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3029