Chronic Pain in the 65+: Evaluating Functional Impacts

慢性疼痛困扰着大约50%的社区老年人，并可能导致身体，心理和认知功能的严重破坏。尽管这一潜在的破坏性问题普遍存在，但缺乏使用全面多维模型的老年人慢性疼痛的良好对照研究。 慢性腰痛（CLBP）是老年人最常见的慢性疼痛病症之一，影响美国约600万年龄大于或等于65岁的人。 CLBP提供了一个强大的模型，用于研究老年人慢性疼痛的综合功能影响，因为观察到的身体能力，自我报告的残疾和病理学的可靠和有效的措施，已经专门为腰痛患者开发。 这项调查的目的是扩大我们对老年慢性疼痛患者残疾的理解。 具体而言，我们将探索（1）CLBP对200名年龄大于或等于65岁的社区居住老年人的身体、心理和认知功能的影响程度，与200名无疼痛对照受试者相比，（2）CLBP相关的心理和神经心理功能障碍对身体功能的影响，以及（3）是否可以使用在年轻慢性疼痛患者中已经证明的多轴分类法对患有慢性疼痛的老年人进行分类。 基于实验室的体能测试方案旨在使用人体工程学相关任务（例如，举起，到达）。 其他全面的多维评估指标将包括与老年人特别相关的指标，如疼痛强度、身体表现的临床指标、残疾、睡眠、情绪、自我效能、神经心理功能的详细指标以及健康和幸福的自我感知。 这项研究代表了第一个控制良好的，全面的检查慢性疼痛对可能受到功能下降风险威胁最大的个人的影响，即社区居住的老年人。 一旦慢性疼痛的影响得到全面描述，只有这样才能制定有效的治疗方案，以帮助改善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.