Renata Antunes Lopes

Association Between the Plasma Levels of Mediators of Inflammation With Pain and Disability in the Elderly With Acute Low Back Pain: Data From the Back Complaints in the Elders (BACE)-Brazil Study.

Study Design. Cross-sectional study with subsample of elderly women with acute low back pain (LBP), from Back Complaints in the Elders-Brazil (BACE-Brazil) Objective. To investigate the association between plasma levels of mediators of inflammation (interleukin-1 beta (IL-1&bgr;), IL-6, tumor necrosis factor alpha (TNF-&agr;), and soluble TNF receptor 1 (sTNF-R1)) with pain and disability experienced by elderly women with acute LBP. Summary of Background Data. Among the elderly, LBP is a complaint of great importance and can lead to disability. Inflammatory cytokines are elevated in painful conditions, and may promote pain. Methods. We included 155 community-dwelling elderly women (age ≥ 65 yr), who presented with a new (acute) episode of LBP. Enzyme-linked immunosorbent assays were used to measure TNF-&agr;, sTNF-R1, IL-1&bgr;, and IL-6. Disability was assessed using the Roland Morris Disability Questionnaire; pain was assessed using the McGill Pain Questionnaire. Linear regression models were fit with each pain and disability outcome as dependent variables: Present Pain Intensity; Qualities of pain; Severity of pain in the last week; LBP frequency and disability. Results. Depressive symptoms and IL-6 were associated and explained 20.9% of “qualities of pain” variability. TNF-&agr;, sTNFR1, education, body mass index, and depressive symptoms explained 8.4% of “Severity of pain in the past week” variability. TNF-&agr;, education, BMI, depressive symptoms, present pain intensity, qualities of pain, and LBP frequency explained 48.6% of “disability.” No associations between inflammatory cytokines and “present pain intensity” and “LBP frequency” were found. Conclusion. Our results demonstrate associations between inflammatory markers (TNF-&agr; and sTNFR1) and pain severity, IL-6 was associated with the qualities of pain, and TNF-&agr; was also associated with disability. These inflammatory mediators represent new markers to be considered in the assessment and treatment of elderly patients with LBP. Level of Evidence: 5

Functional performance and plasma cytokine levels in elderly women with and without low back pain

BACKGROUND AND OBJECTIVES Low back pain (LBP) is a complaint of great importance among the elderly due to its significant impact on function. LBP could contribute to changes in the regulatory process of inflammatory mediators observed in elders. The aim of this study was to compare plasma levels of interleukin(IL)-6, soluble tumor necrosis factor receptor 1(sTNF-R1), and functionality among 3 groups of elderly women: GI, with LBP; GII, without LBP but reports of other pain; and GIII, without any reported pain. MATERIAL AND METHOD This was an observational study of a subsample of the international Back Complaints in the Elders cohort study. IL-6 and sTNF-R1 were measured using the enzyme-linked immunosorbent assay. Functionality was assessed using the Timed Up and Go, gait speed and Roland Morris Disability Questionnaire; and pain, using the numerical pain scale. RESULTS Two hundred and thirteen women aged 71.35 ± 4.76 years were included. GI presented the highest sTNF-R1 levels (p=0.016), worst TUG performance (p< 0.001) and slowest gait speed (p< 0.01) compared to GII and GIII, which were similar (p > 0.05). No difference was found between the IL-6 plasma levels in any of the groups. CONCLUSION Elderly women with LBP had the highest sTNF-R1 plasma levels and the worst functional performance compared to elderly women with reports of other pain (not LBP) or no pain.

Risk of falls in Brazilian elders with and without low back pain assessed using the Physiological Profile Assessment: BACE study

ABSTRACT Background Low back pain (LBP) is a common musculoskeletal condition among elders and is associated with falls. However, the underlying biological risk factors for falling among elders with LBP has been poorly investigated. The Physiological Profile Assessment (PPA) is a validated fall-risk assessment tool that involves the direct assessment of sensorimotor abilities and may contribute to the understanding of risk factors for falls among elders with LBP. Objective To assess fall risk using the PPA in elders with and without LBP. Method This is an observational, comparative, cross-sectional study with elders aged ≥65 years. The present study was conducted with a subsample of participants from the Back Complaints in the Elders (BACE) - Brazil study. Fall risk was assessed using the PPA, which contains five tests: visual contrast sensitivity, hand reaction time, quadriceps strength, lower limb proprioception, and postural sway. Results Study participants included 104 individuals with average age of 72.3 (SD=4.0) years, divided into two groups: GI) 52 participants with LBP; GII) 52 participants without LBP. The participants with LBP had a significantly higher fall risk (1.10 95% CI 0.72 to 1.48), greater postural sway (49.78 95% CI 13.54 to 86.01), longer reaction time (58.95 95% CI 33.24 to 84.65), and lower quadriceps strength (–4.42 95% CI –8.24 to –0.59) compared to asymptomatic participants. There was no significant difference for vision and proprioception tests between LBP and non-LBP participants. Conclusion Elders with LBP have greater risk for falls than those without LBP. Our results suggest fall-risk screening may be sensible in elders with LBP.

Psychometric properties of the Brazilian version of the Pain Catastrophizing Scale for acute low back pain

Measurement instruments of pain catastrophizing for middle-aged and elderly individuals are needed to understand its impact on low back pain. The goals were to cross-culturally adapt the Pain Catastrophizing Scale, assess the construct validity through Rasch analysis, and verify reliability and convergent validity of pain catastrophizing with psychosocial factors. 131 individuals aged 55 years and older with acute low back pain were interviewed . The intra-rater reliability was Kp = 0.80 and interrater Kp = 0.75. The Rasch analysis found adequate reliability coefficients (0.95 for items and 0.90 for individuals ). The separation index for the elderly was 2.95 and 4.59 items. Of the 13 items, one did not fit the model, which was justified in the sample evaluated. The pain catastrophizing correlated with most psychosocial factors. The instrument proved to be clinically useful. Subsequent studies should carry out the same analysis in different populations.

Inflammatory Mediators and Pain in the First Year After Acute Episode of Low-Back Pain in Elderly Women: Longitudinal Data from Back Complaints in the Elders—Brazil

Objective The aims of this study were to determine the course of plasma levels of inflammatory mediators (interleukin 6 [IL-6], tumor necrosis factor &agr; [TNF-&agr;], soluble TNF receptor 1 [sTNF-R1]) and the severity of low-back pain (LBP) over 6 to 12 months after an acute episode of LBP in elderly women and to establish an association between inflammatory mediators and LBP recovery. Design This was a longitudinal study of a subsample (155 elderly women with acute LBP, aged ≥65 years) of the international Back Complaints in the Elders cohort study. Plasma levels of IL-6, TNF-&agr;, and sTNF-R1 were measured using enzyme-linked immunosorbent assays and pain severity using the numerical pain scale. Results There was a decrease in the severity of LBP (P = 0.033) and in the levels of IL-6 and TNF-&agr; (P < 0.001) and an increase in sTNF-R1 (P < 0.001) in the first year after an acute episode of LBP. The probability of occurrence of pain relief at the 12-month follow-up was 2.22 times higher in elderly women who had low levels of IL-6 (<1.58 pg/mL) at baseline. Conclusions Our findings showed a relationship between inflammation and LBP by establishing that low IL-6 plasma levels preceded outcome (LBP recovery), supporting the concept that proinflammatory cytokines promote pain.

O papel da catastrofização da dor no prognóstico e tratamento de idosos com osteoartrite de joelho: uma revisão crítica da literatura

Total knee arthroplasty performed on patients with severe osteoarthritis can lead to improvement in pain, physical function and quality of life. However, some individuals have negative results after this procedure. Pain catastrophizing has been identified as the most important psychological predictor for worse outcomes after surgery. This study aimed to review the literature about the influence of pain catastrophizing on prognosis and treatment of elderly subjects with knee osteoarthritis. Literature search was performed in Medline via PubMed, Embase, Cochrane, Scopus, Science Direct, MedCarib, SciELO, LILACS and Google until June 2012. The search yielded a total of 2,227 articles, and after exclusion by title, abstract and full text, six studies were included. All items shown as a common feature of treatment as TKA surgery. Although the analysis of other variables such as depression, anxiety, pain severity and disability, catastrophizing was considered the only variable that significantly contributes to the results of the recovery after arthroplasty, contributing to longer hospital stays, more pain and deterioration in functionality. It is necessary to put basic measures into practice to identify individuals who are more catastrophizers and thus psychosocial interventions may be needed to promote a more positive recovery in individuals presenting a profile of psychosocial risk, reducing the length of hospitalization.