Multi-site pain was found to be common in older adults with persistent back pain and be associated with greater back pain intensity and poorer quality of life, according to a study published in Pain Medicine.

A total of 899 adults with persistent back pain were enrolled from 3 integrated health systems in the United States. Participants also reported pain in stomach, arms/legs/joints, headaches, neck, pelvis/groin, and widespread pain. Study participants were followed for 18 months after enrollment, during which time investigators assessed back-related disability with the Roland Morris Disability Questionnaire (RMDQ), scored on a 0 to 24 scale; pain intensity with an 11-point numeric rating scale; health-related quality of life with the EuroQol-5D (EQ-5D); utility (from 0 to 1); and falls in the previous 3 weeks. Mixed-effects models were used to determine associations between the number and type of pain sites with each outcome.

Of the 899 participants, 839 (93%) reported ≥1 additional pain site, with 216 (24%) reporting 1 additional pain site, and 623 (69%) reporting multiple additional pain sites. The most commonly reported additional pain site was the arms/legs/joints (89.1%; n=801).

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In every additional pain site, the RMDQ score was found to worsen by 0.65 points (95% CI, 0.43-0.86), back pain intensity was found to increase by 0.14 points (95% CI, 0.07-0.22), EQ-5D worsened by 0.012 points (95% CI, −0.018 to −0.006), and the odds of falling increased by 27% (odds ratio, 1.27; 95% CI, 1.12-1.43).

Extremity pain, widespread pain, and pelvis/groin pain were found to be associated with greater long-term disability.

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“In future studies of older adults with back pain, it may be useful to include [a] number of other pain sites as a potential confounder or moderator,” the researchers wrote.

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Rundell SD, Patel KV, Krook MA, et al. Multisite pain is associated with long-term patient-reported outcomes in older adults with persistent back pain. [published online January 5, 2019]. Pain Medicine. doi:10.1093/pm/pny270