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In Brief

Clinical news

Spinal pain may be an indicator of poor health

By Nicole MacKee
Older people with spinal pain have a 13% increased risk of death per year lived, according to researchers who say the association is unlikely to be causal, but reflects poor health and poor functional ability. 

The researchers analysed data from 4391 Danish twins – aged 70 years and older with no history of coronary heart disease (self-reported) – and found that low back or neck pain was associated with an increased rate of all-cause mortality (hazard ratio [HR], 1.13; 95% confidence interval [CI]: 1.06-1.21). They found no association between spinal pain and cardiovascular disease. 

After adjusting for confounders, such as baseline physical functional ability and depressive symptoms, the researchers found the association between spinal pain and mortality became nonsignificant. 

‘Spinal pain in the aged is an indicator of poor health and poor functional ability, which increases mortality risk,’ the researchers wrote in the European Journal of Pain

Genetic and early childhood factors were not shown to have a role in the association, said the researchers, who conducted a co-twin intra-pair analysis of the data. 

The Director of the Monash Department of Clinical Epidemiology and Professor in the Monash University Department of Epidemiology and Preventive Medicine in Melbourne, Professor Rachelle Buchbinder, said the findings had been ‘widely misrepresented’ in the mainstream media, with many outlets reporting a causal link between back pain and earlier death. 

Many mainstream stories had also illustrated the findings using images of people much younger than the study participants, which added to the confusion, she said. 

‘The most important message – for both clinicians and [patients] – is that people with back pain do not need urgent treatment of back pain to avoid dying’, said Professor Buchbinder. ‘People with back pain have generally poorer health and this is why they die.’ 

Professor Buchbinder said there was a high prevalence of back pain across the age spectrum, but it was more disabling in older people. 

‘Back pain shouldn’t be dismissed at any age. Management of nonspecific low back pain is education and maintaining physical activity and a healthy lifestyle, irrespective of age,’ she said. 

Associate Professor Roger Goucke, Clinical Associate Professor at the University of Western Australia and a consultant in the Department of Pain Management at Perth’s Sir Charles Gairdner Hospital, said the findings were not surprising. 

’If you’re old, overweight, don’t exercise, and have back pain – and don’t have heart disease – you’re likely to die earlier than somebody who is old, a healthy weight, exercises, and doesn’t have back pain,’ he said. ‘It’s detecting nonspecific measures of health.’ 

Associate Professor Goucke said the findings could help clinicians to encourage older people to be as active as possible for as long as possible. 

‘Physical activity is the treatment of back pain, and it will give you a health benefit as well.’
Eur J Pain 2017; 21: 938-948. 

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