Pain Provocation and the Energy Cost of Walking: A Matched Comparison Study of Older Adults With and Without Chronic Low Back Pain With Radiculopathy.
Peter C Coyle, Jenifer M Pugliese, J Megan Sions and 3 others
PMID 30998562WHAT IT FOUND
Older adults with chronic low-back radicular pain whose pain rose by at least 2 points while walking had a higher energy cost by the end of the test.
Those whose pain did not rise, and matched pain-free controls, did not change energy cost.
Key findings
01Among older adults with CLBPR who had a clinically relevant pain increase of at least 2 points during walking, energy cost rose significantly from early to late walking, with a median difference of 0.003 mL/kg/m.
02Compared with matched pain-free controls, the CLBPR pain-increase group walked 446.9 m shorter, walked 0.24 m/sec slower early and 0.37 m/sec slower late, and reported higher late-stage perceived exertion.
03In the CLBPR pain-increase group, higher late-stage pain intensity was a significant contributor to the percent change in energy cost after controlling for covariates and early-stage pain, with unstandardized beta 6.14 and p 0.040.
STILL TO COME
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What it does not show
The study was small and convenience-sampled, with 21 participants in each main group. One participant with CLBPR and one matched control were excluded from the energy-cost analyses because the person did not walk long enough. Participants who needed an assistive device, had severe cardiopulmonary disease, progressive neurological disease, or terminal illness were excluded, so the results do not show what happens in older adults with more limited mobility or common comorbidities. This was an observational walking test, not a treatment study. It cannot show that reducing pain will lower energy cost or prevent mobility decline. The study did not measure gait mechanics, so it cannot identify why energy cost changed when pain increased. The regression result was affected by one outlier. After removing it, the explained variance dropped from 47.2% to 41.2%, although significance remained. Participants with CLBPR were heterogeneous in symptom duration, laterality, and quality, and matching was only on age, sex, and diabetes status.
Declared interests
The authors declared no conflicts of interest. The supplied article text does not state a funder; the publication types indicate NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that treating pain during walking will improve energy cost or mobility. The study observed a 20-minute walking test in 21 adults with CLBPR and 21 controls, and it did not test any treatment.