How pain expedites the aging process: improving our understanding of disability development in older adults with chronic low back and radicular leg pain
Date
2017
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Publisher
University of Delaware
Abstract
Background: Chronic musculoskeletal pain is prevalent, costly, and disabling among older adults. Decreases in walking speed are a hallmark sign of the age-related deterioration of mobility, and are more pronounced among those with chronic musculoskeletal pain. Walking speed is strongly predictive of adverse health outcomes, such as institutionalization and mortality. Although we are unsure why this occurs, recent evidence suggests that the age-related decline in walking speed may be due, in large part, to impaired energetic efficiency and energetic capacity. The combination of pain in the presence of age may have an important impact on this metabolic pathway. Rehabilitation interventions targeted at points along this pathway may improve pain-related disability. ☐ Purpose: We aim to: 1) propose a new conceptual framework to enhance the understanding of the energetic mechanisms behind the deterioration of mobility among older adults with pain; 2) test different aspects of this model using different patient populations and study designs; 3) provide insight as to the clinical implications that this new model possesses. ☐ Methods: Hypotheses will be investigated using two different study designs. First, the energetic efficiency and energetic capacity of older adults with chronic low back and radicular leg pain will be explored; this patient population offers a unique insight into the relationship between pain and energy expenditure, because their symptoms are provoked with walking. Second, we will conduct a secondary analysis of a longitudinal dataset to examine the potential predictive relationship that energy efficiency has on energetic capacity, and to investigate the influence that lumbopelvic pain has on this relationship, among older adults. ☐ Significance: Validation of this conceptual model will have important clinical implications. If energetic efficiency and energetic capacity are impacted by the presence and provocation of chronically painful conditions, then they will be important clinical targets for rehabilitation. Our findings lend support to this model. Provocation and the mere presence of chronic low back and radicular leg pain are linked to worse energetic efficiency and capacity. Longitudinally, energetic efficiency is predictive of changes in energetic capacity, and this relationship may be moderated by the presence of severe lumbopelvic pain.