Susan J. Lieber

An interdisciplinary expert consensus statement on assessment of pain in older persons

This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.

The impact of chronic low back pain on older adults: A comparative study of patients and controls

Abstract Chronic low back pain (CLBP) is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. Many older adults remain quite functional despite CLBP, and because age‐related comorbidities often exist independently of pain (e.g., medical illnesses, sleep disturbance, mobility difficulty), the unique impact of CLBP is unknown. We conducted this research to identify the multidimensional factors that distinguish independent community dwelling older adults with CLBP from those that are pain‐free. Three hundred twenty cognitively intact participants (162 with ⩾moderate pain for ⩾3 months, and 158 pain‐free) underwent comprehensive assessment of pain severity, medical comorbidity (illnesses, body mass index, medications), severity of degenerative disc and facet disease, lumbar flexion, psychological constructs (self‐efficacy, mood, overall mental health), and self‐reported as well as performance‐based physical function. Significant differences were ascertained for all 22 measures. Discriminant function analysis revealed that eight measures uniquely maximized the separation between the two groups (self‐reported function with the Functional Status Index and the SF‐36, performance‐based function with repetitive trunk rotation and functional reach, mood with the Geriatric Depression Scale, comorbidity with the Cumulative Illness Rating Scale and BMI, and severity of degenerative disc disease). These results should help to guide investigators that perform studies of CLBP in older adults and practitioners that want an easily adaptable battery for use in clinical settings.

Psychosocial predictors of physical performance in disabled individuals with chronic pain.

ObjectivesFirst, to identify what physical performance differences existed between a group of disabled individuals with chronic pain and a control group of pain-free individuals with comparable disabilities; and second, to test a psychosocial model designed to evaluate which psychosocial constructs were predictive of performance in disabled individuals with chronic pain. DesignCase-comparison study. SettingAmbulatory university laboratory. ParticipantsA community sample of 62 individuals with lower limb amputations or paraplegia, 31 with chronic pain and 31 pain-free. InterventionStandardized lifting and wheel-turning tasks. Main Outcome MeasuresStatic strength, endurance, lifting speed, lateral and anterior–posterior sway, and multidimensional psychosocial measures. ResultsDisabled individuals with chronic pain had decreased endurance for both the lifting (p <0.001) and the wheel-turning (p <0.05) tasks. A psychosocial model of physical performance also was evaluated. Using confirmatory factor analysis, 31 measures were used to validate 8 theoretical constructs: emotional functioning, pain intensity, pain cognitions, physical functioning, social functioning, task-specific self-efficacy, performance outcome, and performance style. Regression analyses indicated that more than 90% of the variance in performance was predicted by psychosocial factors, with self-efficacy, perceived emotional and physical functioning, pain intensity, and pain cognitions showing the highest associations. ConclusionsChronic pain was found to significantly reduce the performance in individuals with lower limb amputations and paraplegia. A strong association was found between performance and psychosocial factors in disabled individuals with chronic pain. These findings extend the existing literature by validating that psychosocial models of chronic pain can be applied to the disabled population, with results similar to those of other chronic pain samples.

Efficacy of percutaneous electrical nerve stimulation for the treatment of chronic low back pain in older adults.

OBJECTIVES: To determine the efficacy of a complementary analgesic modality, percutaneous electrical nerve stimulation (PENS), for the treatment of chronic low back pain (CLBP) in community‐dwelling older adults.

Body motion during repetitive isodynamic lifting: a comparative study of normal subjects and low-back pain patients ☆

To quantify performance differences between patients with low‐back pain (LBP) and a control group during their performance of a repetitive isodynamic lifting task. Case–control study was done. LBP patients were recruited and tested at an outpatient ambulatory chronic pain rehabilitation program before treatment was begun. Fifty‐three LBP patients who had prolonged back pain and 53 age and gender matched pain‐free control subjects. Overall lifting performance measures included weight lifting and number of lifts completed; kinematic measures of hip and knee movements during lifting were described by hyperbolic tangent models, and included static measures of starting and ending angles, and dynamic measures of midpoint, falltime, and lift speed. Control subjects completed significantly more lifts and lifted more weight than patients. Starting hip flexion was greater for controls and starting knee flexion was greater for patients, indicating that patients used more of a leg lift. Patients and controls also differed significantly on dynamic measures, particularly lifting speed and hip and knee temporal midpoints. Major static and dynamic motion differences were found between LBP patients and controls as they performed repetitive lifting under a constant load. These findings indicate that body motion parameters, in addition to more common strength and endurance measures, are necessary to describe the impact of persistent LBP on a persons lifting abilities.

Classifying Subgroups of Chronic Low Back Pain Patients Based on Lifting Patterns

OBJECTIVE To compare self-reported measures of chronic lower back pain (CLBP) patients who were assigned to 2 subgroups based on their lifting patterns performed during a repetitive lifting task. DESIGN Cross-sectional study. SETTING Research laboratory PARTICIPANTS CLBP subjects (n=81) and pain-free controls (n=53). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Measures of lifting patterns and self-reported disability, pain, and psychosocial aspects. RESULTS Two CLBP subgroups were found: 1 group that lifts similarly to control subjects (n=35) and 1 group that lifts very differently from controls (n=46). The CLBP group that lifted differently than controls reported higher pain intensity (P=.005), higher pain severity (P=.025), and lower self-efficacy (P=.013) than the CLBP group that lifted similarly to controls. CONCLUSIONS A classification system based on lifting patterns identified 2 CLBP subgroups that were significantly different on lifting and self-reported measures, indicating the importance of physical functioning measures in classification systems.

495 THE IMPACT OF LOW BACK PAIN AND AGE ON PHYSICAL PERFORMANCE MEASURES IN OLDER ADULTS

emphases general practioner mistake in prescribing tramadol without clear pain diagnosis. Also, patient had potential for addiction as well as an easy access to the drug. Another patient prescription of tramadol was in the manner “as needed”, only according to patient complaints without clear pain assessment and objective pain diagnosis. Caregiver ordinated the drug for sedation and the consequence was acute confusional state of patient with agitation and hallucinations. Third one suffered from neuromuscular pain due to arthropaty and find relief using tramadol, but because of forgetfulness used it more frequently than it was prescribed. Conclusion: Use of tramadol in this kind of circumstances requires the multidisciplinary approach and cooperation between pain specialist, general practioners, psychiatrist, caregivers, relatives and patients.