Pain Provocation and the Energy Cost of Walking: A Matched Comparison Study of Older Adults With and Without Chronic Low Back Pain With Radiculopathy

Review written by Dr Mariana Wingood info

Key Points

  1. Older adults with chronic low back pain with radiculopathy have a higher rate of energetic impairment (as measured by oxygen consumption), lower leg strength, and lower functional endurance. This can lead to increased risk of poor health outcomes.
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BACKGROUND & OBJECTIVE

Older adults often experience lumbar pain that radiates into a lower extremity (1,2). Unfortunately, this common hallmark sign of chronic low back pain with radiculopathy (CLBPR) can lead to ambulation limitations and a decrease in gait speed (1,2). Consequently, individuals with CLBPR have higher rates of energetic impairment (as measured by oxygen consumption), lower leg strength, and lower functional endurance, resulting in increased risk for poor health outcomes (3). In addition to this, the energetic impairment can also result in decreased ambulation distance and therefore CLBPR predicts a decline in gait speed (4). This is concerning for multiple reasons, including the association between gait speed and decreased quality of life and higher risk of disability and mortality (5,6).

To explain these various associations and relationships, researchers have used a combination of models (7,8). In Figure 1, you can see how some of these models intertwine. Secondary to these models and previous research, the authors of this paper hypothesized that among older adults with CLBPR there is an increase in pain intensity that is linked to an increase in the energy cost of ambulation. To examine this hypothesis, the authors evaluated the impact of pain provocation on the energy cost of walking at self-selected speeds (i.e. energy efficiency) in older adults with CLBPR.

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Chronic low back pain with radiculopathy can lead to ambulation limitations and a decrease in gait speed.
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Pain management with walking may be an important factor in decreasing the energy cost of walking and thus preventing mobility decline.

METHODS

Design: Matched comparison study using a case-control design. Participants:

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