Disabling back pain increases mortality risk for older women

Disabling back pain puts women in their 70s at an increased risk of death, findings from the Cambridge City over-75s Cohort study suggest.

The findings confirm those from other studies of working age people indicating a relationship between back pain and increased mortality, say the researchers.

“In addition, we present new data to suggest that this association may be limited to disabling pain and appears to be specific to women”, they add.

The researchers, led by Rachael Docking (University of Aberdeen, UK), collected comprehensive data on back pain and the degree to which it affected daily life for 1174 participants aged at least 75 years.

Back pain was considered disabling if it had interfered with daily tasks within the preceding month.

The average age of the participants was 85 years and 65% were female. The date of death was known for 1158, with 15 known to be still living and one untraceable since moving abroad.

In all, 65 (6%) of the participants had disabling back pain, the rate of which increased with age, so that participants over 90 years of age were more than twice as likely to have disabling pain as those aged 70–79 years.

Its presence increased the likelihood of death a significant 1.4-fold compared with no back pain, and it remained a significant predictor, albeit of borderline significance, after adjustment for sociodemographical variables and potential confounders such as use of medication, shortness of breath and falls.

Women were more likely than men to experience disabling back pain, at 7.2% versus 2.7%, and it increased their risk of death a significant 1.4-fold after adjusting for confounders. Any increased risk of death associated with disabling back pain in men disappeared after adjustment for sociodemographical and health-related variables.

“[I]t may be that chronic or disabling pain may be aetiologically different between men and women”, the researchers comment in the European Journal of Pain.

They suggest that patients with disabling or chronic pain may have lifestyles characterised by factors that could increase the risk of death, such as lower levels of physical activity, manual work or a poor diet.

But the team calls for further research to investigate the mechanisms underlying the relationship between pain and mortality and examine the specific conditions causing disabling back pain for possible secondary prevention.

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