Chronic low back pain in the 65+: is PEN effective?

持续性肌肉骨骼疼痛困扰着大约50%的社区老年人，并导致身体、心理社会和认知功能障碍。尽管这种潜在的破坏性问题普遍存在，但利用全面的多学科结果模型来评估治疗效果的老年人持续性疼痛的良好对照研究尚不多见。现有研究包括异质性病理的受试者，有不足之处 对照组，使用自我报告来衡量治疗的反应，而不是实际的体力表现衡量，不包括认知能力的衡量。此外，以前的研究中的治疗干预并不严格。目的 建议的研究之一是使用经皮神经电刺激(PENS)治疗与骨关节炎(OA)相关的持续性下腰痛作为模型，以检验老年人持续性疼痛治疗的多学科效果。此外，通过使用非药物干预，我们将能够检查疼痛本身及其通过治疗改善对身体、心理社会和认知表现的影响。最近是这样的 有人认为，使用针灸加电流的钢笔治疗下腰痛可能比单纯针灸更好。使用随机对照实验设计，20名年龄大于65岁、患有持续性下腰痛和腰骶骨关节炎但没有其他功能性限制性疼痛条件的社区老年人将接受物理治疗加钢笔治疗，每周两次，持续6周，20名受试者将接受 物理治疗加上假钢笔。将在基线、治疗结束时和3个月后评估对疼痛强度、睡眠、认知功能、情绪、体力表现和对日常任务表现的干扰的影响。如果有益，这项试验性研究可能会导致各种决定性的研究努力，旨在开发更有效的策略来治疗和了解老年人持续性骨性关节炎相关下腰痛的治疗反应。

Persistent musculoskeletal pain plagues approximately 50% of community dwelling older adults, and causes physical, psychosocial and cognitive dysfunction. Despite the prevalence of this potentially devastating problem, well controlled studies of persistent pain in older adults that utilize a comprehensive multidisciplinary model of outcome to assess treatment efficacy are lacking. Existing studies include subjects with heterogeneous pathology, have inadequate control groups, measure the response to treatment using self-report as opposed to actual measures of physical performance, and do not include measures of cognitive performance. In addition, treatment interventions in previous studies have not been rigorous. The purpose of the proposed research is to use persistent low back pain related to osteoarthritis (OA) treated using percutaneous electrical nerve stimulation (PENS) as a model for examining the multidisciplinary effects of persistent pain treatment in the older adult. In addition, by using a non-pharmacologic intervention, we will be able to examine the effects of pain per se and its improvement with treatment on physical, psychosocial and cognitive performance. It has recently been suggested that PENS, which utilizes acupuncture needles plus electrical current, may be superior to acupuncture alone to treat low back pain. Using a randomized controlled experimental design, 20 community dwelling older adults greater than age 65 with persistent low back pain and lumbosacral osteoarthritis, but without other functionally limiting pain conditions, will receive physical therapy plus PENS, twice a week for 6 weeks, and 20 subjects will receive physical therapy plus sham PENS. Effects on pain intensity, sleep, cognitive function, mood, physical performance, and interference with performance of everyday tasks will be assessed at baseline, at the completion of treatment and 3 months later. If beneficial, this pilot study could lead to a variety of definitive investigative efforts geared toward developing more effective strategies to treat and understand the treatment responses of persistent OA-associated low back pain in older adults.