Daily Back Pain May Have Adverse Health Effects in Elderly Women

August 23, 2007 — Daily back pain is associated with decreased quality of life, mobility, longevity, and increased risk for coronary heart disease (CHD) in elderly women, according to the results of a study reported in Spine.
"The consequences of back pain in elderly people have not been well studied, perhaps because its high frequency has resulted in the symptom being regarded as 'normal'," write Kun Zhu, PhD, from the Sir Charles Gairdner Hospital in Nedlands, WA, Australia, and colleagues. "Because there has been no study that investigated the association between the frequency of back pain, a good index of the severity of back pain, and the risk of incident heart disease and mortality, the aim of this study was to assess the prevalence of self reported back pain frequency at baseline and 5 years later in a community based cohort of 1484 elderly Australian women and evaluate its long-term impact on the health of the individuals with this complaint."
The investigators analyzed data from 1484 community-dwelling Australian women 70 to 85 years old who were enrolled in a 5-year randomized controlled trial of calcium intervention with observational cohort design.
Outcomes measured at baseline and at 5 years were frequency of back pain based on self-report, mobility measured with the Timed Up and Go Test (TUAG), and Quality of Life on the Medical Outcome Study Short Form-36 (SF-36) questionnaire. Data on cause of deaths were obtained from death certificates available for all deaths during 5 years, and incident data on CHD were determined from patients' diaries and confirmed by review of records of primary care clinicians and medications.
Frequency of back pain was characterized as infrequent (< 1/month), frequent (1/month to 1/day), or daily (1/day). At baseline and at 5 years, 21.7% and 26.9% of participants reported daily back pain, and 27.6% and 24.4% subjects reported frequent back pain.
TUAG at baseline and at 5 years showed that participants with daily back pain had significantly lower quality-of-life physical component scores and mobility than did those with infrequent back pain.
After adjustment for baseline age, daily back pain was associated with greater overall risk for mortality (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.14 - 3.60) and greater risk for mortality from CHD and a new diagnosis of CHD (HR, 2.13; 95% CI, 1.35 - 3.34). After additional adjustment for cardiovascular risk factors and level of physical activity, these effects remained significant.
"Daily back pain is associated with reduced quality of life, mobility and longevity and increased risk of coronary heart events," the investigators write. "The adverse health effects of chronic back pain deserve greater recognition."
Limitations of the study include lack of generalizability beyond relatively healthy, community-dwelling elderly women in higher socioeconomic categories; exclusion of women who were receiving bone-active agents, including calcium supplements; and 5-year follow-up data available for only 79.3% of subjects.
"Management of back pain and health conditions related to back pain is likely to be important in the maintenance of functional independence and well-being of elderly women," the study authors conclude.
The Healthway Health Promotion Foundation of Western Australia, the Australasian Menopause Society, and the National Health and Medical Research Council of Australia supported this study.
Spine. 2007;32:2012-2018.