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

持续的肌肉骨骼疼痛困扰着大约50%的社区老年人，并导致身体、社会心理和认知功能障碍。尽管这种潜在的破坏性问题普遍存在，但缺乏对老年人持续性疼痛的良好对照研究，这些研究利用综合的多学科结果模型来评估治疗效果。现有的研究包括具有异质病理的受试者，没有足够的对照组，使用自我报告而不是实际的身体表现测量来测量对治疗的反应，并且不包括认知表现的测量。此外，先前研究中的治疗干预措施并不严格。本研究的目的是利用经皮神经电刺激（PENS）治疗与骨关节炎（OA）相关的持续性腰痛作为模型，研究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的影响以及治疗对身体，心理社会和认知表现的改善。最近有人提出，使用针刺针加电流的PENS治疗腰痛可能优于单独针灸。采用随机对照实验设计，20名年龄大于或等于65岁的社区老年人患有持续性腰背痛和腰骶骨关节炎，但没有其他功能限制性疼痛状况，将接受物理治疗加PENS，每周两次，持续6周，另外20名受试者将接受物理治疗加假PENS。对疼痛强度、睡眠、认知功能、情绪、身体表现和对日常工作的干扰的影响将在基线、治疗完成时和3个月后进行评估。如果有益的话，这项初步研究可能会导致各种明确的调查工作，旨在制定更有效的策略来治疗和了解老年人持续性oa相关腰痛的治疗反应。

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 or equal to 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.