Study associates back pain with mortality in older women

Back pain is the leading cause of disability worldwide, and women aged 40-80 years have the highest prevalence of back pain. Also, women report more frequent and debilitating back pain compared to men.

Researchers found that frequent, persistent back pain is associated with earlier death in a study of more than 8,000 older women who were followed for an average of 14 years. After controlling for important socio-demographic and health factors, women who reported frequent, persistent back pain had a 24 per cent increased risk of death compared to women with no back pain.

Published in the Journal of General Internal Medicine, the study found that disability measured after back pain helped explain the association.

"To our knowledge, our study is the first to measure disability after measurement of back pain. This allowed for a prospective analysis of back pain that persisted over time and later rates of disability, which may help explain the association between back pain and mortality," said Eric Roseen, a researcher. "Our findings raise the question of whether better management of back pain across the lifespan could prevent disability, improve quality of life, and ultimately extend life."

After taking baseline measurements of back pain, researchers followed up with participants two years later and measured back pain again. In year four, participants were asked about and observed doing common activities of daily living. The study found that disability following the measurements of back pain explained much of the association with mortality.

Specifically, difficulty performing one or more basic daily activities, like walking short distances or meal preparation, explained nearly half (47 percent) of the effect of frequent persistent back pain on mortality. Slow performance on more objective measures, like observed walking speed or repetitive standing up from a chair, each explained about a fourth of this association (27 per cent and 24 per cent, respectively). Of 8,321 women in the study, 56 per cent died over a median follow up of 14.1 years. A higher proportion of women with frequent persistent back pain died (65.8 per cent) than those with no back pain (53.5 per cent).

"Back pain may directly impair daily activities, but older adults could inappropriately avoid them due to fear of re-injury or worsening of symptoms. Being unable to perform, or avoiding, daily activities could lead to weight gain, development or progression of other chronic health conditions, and ultimately earlier death," said Roseen.