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

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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.