Low Back Pain Severity, Falls, and Falls-Related Injury in Older Adults

Welcome back to SpineIQ’s Back Blog! Most of our blogs summarize studies where the primary outcomes are pain, disability, and return to work. While these are consistently rated as some of the most important outcomes for patients, payers, and clinicians, they are not the only outcomes that matter. In fact, there are numerous other ways that low back pain can impact a person’s life, such as, fall risk.¹ Approximately 684 thousand people have a fatal fall every year around the world.² Falls commonly happen in older adults with risk increasing every decade. In fact, people in their 70’s have double the prevalence of falls than people in their 60’s.² Fall pose a huge health, economic, and disability burden on society. There is some preliminary evidence that suggests older people experiencing low back pain may be more at risk for falls compared to older people without low back pain. However, the evidence is usually in people in their 60’s and has not considered recurrent falls or falls leading to injury. Therefore, this week we are summarizing the clinically relevant findings of a study by Tse et al evaluating the association between low back pain and recurrent falls and the association between level of pain severity and fall-related injuries in people at least 70 years old. ³

Methods

The participants were asked pain-related and fall-related questions in order evaluate their association with each other.

Pain-related questions:

• “Do you experience pain on most days? Yes/No”
• “Where in your body do you feel this pain?”
• “How severe has your pain been most of the time in the last week? 0 (no pain) – 10 (maximum pain)”
  • Participants were categorized based on the answer to this question into: mild (1-3), moderate (4-6) and severe (7-10) pain

Fall-related questions

• “In the past year have you had any falls? Yes/no”
• “How many falls in total have you had in the last 12 months?”
  • Recurrent falls were at least 2 falls
• “In the last 12 months have any of the falls caused an injury such as large cruise, cut or broken bone/fracture? Yes/no”

Results

There was a total of 2,220 participants who reported 1 fall and 1,983 participants who reported at least 2 falls (recurrent fallers). The average age of the participants was 76 years old.

Clinically relevant results:

• 34% reporting low back pain on most days
• 47% reporting falls-related injury
• Participants with severe low back pain were more likely to be recurrent fallers compared to participants with mild low back pain
  • Males were 70% more likely
  • Females were 50% more likely
• Only female recurrent fallers with severe low back pain were more likely (by 30%) to report a falls-related injury compared to female recurrent fallers who reported mild low back pain
  • No association in males

Conclusion

This study provides clinically relevant findings about the importance of conservative spine clinicians for older adults with low back pain. Not only can conservative spine clinicians provide treatment to reduce low back pain, but these findings suggest that reducing the low back pain severity may lead older adult patients to be less likely to fall and female older adult patients to be less likely to have a fall-related injury. Conservative spine clinicians are especially important because older adults are more likely to be taking multiple medications that may not mix well with pharmacological care for low back pain.^4,5 Also, it is important for conservative spine clinicians treating older adults for low back pain to consider risk of falls when creating the care plan with the patient. It may be appropriate for clinicians to recommend balance exercises or ergonomic aids to help reduce the likelihood of falling.
References

1. Marshall LM, Litwack-Harrison S, Cawthon PM, et al. A Prospective Study of Back Pain and Risk of Falls Among Older Community-dwelling Women. J Gerontol A Biol Sci Med Sci. 2016;71(9):1177-1183. doi:10.1093/gerona/glv225
2. James SL, Lucchesi LR, Bisignano C, et al. The global burden of falls: global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Inj Prev. 2020;26(Suppl 2):i3-i11. doi:10.1136/injuryprev-2019-043286
3. Tse A, Ward S, McNeil J, et al. Severe low back or lower limb pain is associated with recurrent falls amongst older Australians. Eur J Pain Lond Engl. Published online July 21, 2022. doi:10.1002/ejp.2013
4. Domenichiello AF, Ramsden CE. The silent epidemic of chronic pain in older adults. Prog Neuropsychopharmacol Biol Psychiatry. 2019;93:284-290. doi:10.1016/j.pnpbp.2019.04.006
5. Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018;10:289-298. doi:10.2147/CLEP.S153458

Click here to see recommended exercises to help older patients with low back pain.