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，心理和认知功能障碍。尽管这种潜在的破坏性问题的流行，良好的控制研究，在老年人的持续性疼痛，利用一个全面的多学科模型的结果，以评估治疗效果是缺乏的。现有研究包括具有异质性病理的受试者，对照组不足，使用自我报告测量对治疗的反应，而不是身体表现的实际测量，并且不包括认知表现的测量。 此外，以前的研究中的治疗干预措施并不严格。拟议研究的目的是使用经皮神经电刺激（PENS）治疗骨关节炎（OA）相关的持续性腰痛作为研究老年人持续性疼痛治疗的多学科影响的模型。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，心理和认知表现的改善。最近有人提出，PENS，利用针灸针加电流，可能是上级针灸单独治疗腰痛。采用随机对照实验设计，20名年龄≥ 65岁、患有持续性腰痛和腰骶骨关节炎但无其他功能限制性疼痛疾病的社区居住老年人将接受物理治疗加PENS，每周两次，持续6周，20名受试者将接受物理治疗加假PENS。将在基线、治疗完成时和3个月后评估对疼痛强度、睡眠、认知功能、情绪、体能和日常任务执行干扰的影响。如果有益的话，这项试点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.