Chronic Pain in the 65+: Evaluating Functional Impacts

慢性疼痛困扰着大约50%居住在社区的老年人，并可能导致身体、心理社会和认知功能的严重破坏。尽管这种潜在的破坏性问题很普遍，但使用全面的多维模型对老年人慢性疼痛进行良好控制的研究尚不多见。慢性下腰痛(CLBP)是老年人最常见的慢性疼痛之一，在美国大约有600万大于或等于65岁的人受到影响。CLBP提供了一个强大的模型，用来研究慢性疼痛对老年人的综合功能影响，因为观察到的体能、自我报告的残疾和病理的可靠和有效的测量方法是专门为下腰痛患者开发的。这项调查的目的是扩大我们对患有慢性疼痛的老年人的残疾的理解。具体地说，我们将探索(1)CLBP对200名年龄大于或等于65岁的社区老年人和200名无痛对照受试者的身体、心理社会和认知功能的影响程度，(2)CLBP相关的心理社会和神经心理功能障碍对身体功能的影响，以及(3)是否可以使用已在较年轻的慢性疼痛患者中展示的多轴分类法对患有慢性疼痛的老年人进行分类。以实验室为基础的体能测试方案旨在使用符合人体工程学的任务(例如，举起、伸展)来评估身体力学、耐力和协调性。其他全面的多层面评估措施将包括那些与老年人特别相关的措施，如疼痛强度、体能、残疾、睡眠、情绪、自我效能的临床衡量标准、神经心理功能的详细衡量标准以及对健康和幸福的自我认知。这项研究是第一次对慢性疼痛对可能受到功能衰退风险威胁最大的个人，即社区居住的老年人的影响进行了良好控制的全面检查。一旦全面描述了慢性疼痛的影响，只有到那时才能制定有效的治疗计划，帮助减轻这些老年美国人的痛苦。

Chronic pain plagues approximately 50 percent of community dwelling older adults, and may cause significant disruption of physical, psychosocial, and cognitive function. Despite the prevalence of this potentially devastating problem, well-controlled studies of chronic pain in older adults that use a comprehensive multidimensional model are lacking. Chronic low back pain (CLBP) is among the most common chronic pain conditions of older adults, affecting approximately 6 million individuals in the United States who are greater than or equal to age 65. CLBP offers a robust model with which to study the comprehensive functional effects of chronic pain in the older adult because of the reliable and valid measures of observed physical capacity, self-reported disability and pathology that have been developed specifically for patients with low back pain. The purpose of this investigation is to broaden our understanding of disability in the older adult with chronic pain. Specifically, we will explore (1) the magnitude of the effect of CLBP on physical, psychosocial, and cognitive functioning in 200 community dwelling older adults greater than or equal to age 65 as compared with 200 pain-free control subjects, (2) the impact of CLBP associated psychosocial and neuropsychological dysfunction on physical function, and (3) whether older adults with chronic pain can be classified using a multiaxial taxonomy that has been demonstrated in younger chronic pain patients. The laboratory-based physical capacities testing protocol is designed to assess body mechanics, endurance and coordination using ergonomically relevant tasks (e.g., lifting, reaching). Other comprehensive multidimensional assessment measures will include those that have particular relevance to older adults, such as pain intensity, clinical measures of physical performance, disability, sleep, mood, self- efficacy, detailed measures of neuropsychological function, and self perceptions of health and well-being. This study represents the first well-controlled, comprehensive examination of the effects of chronic pain on individuals who may be most threatened by the risk of functional decline, that is, community dwelling older adults. Once the effects of chronic pain have been comprehensively described, only then can effective treatment programs be developed to help ameliorate the suffering of these older Americans.