Severe low back or lower limb pain is associated with recurrent falls among older Australians – ScienceOpen
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      Severe low back or lower limb pain is associated with recurrent falls among older Australians

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          Abstract

          Background

          Few studies have explored the impact of low back or lower limb pain severity on recurrent (≥2) falls in older adults.

          Objectives

          Investigate the association between the severity of low back or lower limb pain, and ≥2 falls or falls‐related injuries.

          Methods

          Community‐dwelling Australian males and females in the ASPREE Longitudinal Study of Older Persons (ALSOP), aged 70 years. Self‐reported, cross‐sectional questionnaire data regarding number of falls and falls‐related injuries in the last 12 months; and sites and severity of pain experienced on most days. Adjusted relative risks (RR) were estimated from multivariable Poisson regression models, for males and females separately.

          Results

          Of 14,892 ALSOP participants, 13% ( n = 1983) reported ≥2 falls (‘recurrent fallers’) in the last 12 months. Males and females who reported severe low back, or severe lower limb pain on most days were more likely to report ≥2 falls in the last 12 months compared to those with mild pain (lower back: males RR = 1.70 and females RR = 1.5, p = 0.001; lower limb: males RR = 2.0, p < 0.001 and females RR = 1.4, p = 0.003). Female recurrent fallers who reported severe low back (RR = 1.3, p = 0.029) or lower limb (RR = 1.2, p = 0.024) pain on most days were more likely to report a falls‐related injury in the last 12 months compared to females with mild pain.

          Conclusion

          Severe low back or lower limb pain was associated with an increased likelihood of recurrent falls (males/females) or falls‐related injuries (females only). Assessment of severe low back and lower limb pain should be considered as a priority when undertaking falls‐risk evaluation.

          Significance

          Severe low back pain, or severe lower limb pain is associated with an increased likelihood of recurrent falls in older males and females, and an increased likelihood of falls‐related injuries in older female recurrent fallers. Assessment and management of severe low back and lower limb pain should be prioritized when undertaking falls‐risk assessment. Future longitudinal research is required to further interrogate this relationship and its underlying mechanisms.

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          Most cited references77

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          The CES-D Scale: A Self-Report Depression Scale for Research in the General Population

          L Radloff (1977)
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            What low back pain is and why we need to pay attention

            Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.
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              Sex differences in pain: a brief review of clinical and experimental findings.

              Recent years have witnessed substantially increased research regarding sex differences in pain. The expansive body of literature in this area clearly suggests that men and women differ in their responses to pain, with increased pain sensitivity and risk for clinical pain commonly being observed among women. Also, differences in responsivity to pharmacological and non-pharmacological pain interventions have been observed; however, these effects are not always consistent and appear dependent on treatment type and characteristics of both the pain and the provider. Although the specific aetiological basis underlying these sex differences is unknown, it seems inevitable that multiple biological and psychosocial processes are contributing factors. For instance, emerging evidence suggests that genotype and endogenous opioid functioning play a causal role in these disparities, and considerable literature implicates sex hormones as factors influencing pain sensitivity. However, the specific modulatory effect of sex hormones on pain among men and women requires further exploration. Psychosocial processes such as pain coping and early-life exposure to stress may also explain sex differences in pain, in addition to stereotypical gender roles that may contribute to differences in pain expression. Therefore, this review will provide a brief overview of the extant literature examining sex-related differences in clinical and experimental pain, and highlights several biopsychosocial mechanisms implicated in these male-female differences. The future directions of this field of research are discussed with an emphasis aimed towards further elucidation of mechanisms which may inform future efforts to develop sex-specific treatments.
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                Author and article information

                Contributors
                julia.gilmartin-thomas1@vu.edu.au
                Journal
                Eur J Pain
                Eur J Pain
                10.1002/(ISSN)1532-2149
                EJP
                European Journal of Pain (London, England)
                John Wiley and Sons Inc. (Hoboken )
                1090-3801
                1532-2149
                01 September 2022
                October 2022
                : 26
                : 9 ( doiID: 10.1002/ejp.v26.9 )
                : 1923-1937
                Affiliations
                [ 1 ] Department of Geriatric Medicine Prince of Wales Hospital Randwick New South Wales Australia
                [ 2 ] School of Health University of New South Wales Sydney New South Wales Australia
                [ 3 ] School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
                [ 4 ] Centre for Healthy Brain Ageing University of New South Wales Sydney New South Wales Australia
                [ 5 ] SilverChain Osborne Park Western Australia Australia
                [ 6 ] Monarch Research Institute Monarch Mental Health Group Sydney New South Wales Australia
                [ 7 ] College of Health and Medicine Australian National University Canberra New South Wales Australia
                [ 8 ] Department of Medical Education, Melbourne Medical School The University of Melbourne Parkville Victoria Australia
                [ 9 ] Institute for Health & Sport Victoria University Footscray Victoria Australia
                [ 10 ] Australian Institute for Musculoskeletal Science St. Albans Victoria Australia
                [ 11 ] Department of Medicine Western Health (University of Melbourne) Melbourne Victoria Australia
                Author notes
                [*] [* ] Correspondence

                Julia Fiona‐Maree Gilmartin‐Thomas, Victoria University, 70/104 Ballarat Road, Footscray Victoria 3011, Australia.

                Email: julia.gilmartin-thomas1@ 123456vu.edu.au

                Author information
                https://orcid.org/0000-0002-1783-0161
                Article
                EJP2013 EURJPAIN-D-21-00670
                10.1002/ejp.2013
                9546413
                35862463
                76fc7671-fc86-4e2b-b4b8-e29554c242c9
                © 2022 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 25 June 2022
                : 03 November 2021
                : 16 July 2022
                Page count
                Figures: 0, Tables: 3, Pages: 15, Words: 10464
                Funding
                Funded by: Monash University , doi 10.13039/501100001779;
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                October 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.0 mode:remove_FC converted:07.10.2022

                Anesthesiology & Pain management
                Anesthesiology & Pain management

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