Multi-site Pain Is Associated with Long-term Patient-Reported Outcomes in Older Adults with Persistent Back Pain

Sean D. Rundell, Kushang V. Patel, Melissa A. Krook, Patrick J. Heagerty, Pradeep Suri, Janna L. Friedly, Judith A. Turner, Richard A. Deyo, Zoya Bauer, David R. Nerenz, Andrew L. Avins, Srdjan S. Nedeljkovic, Jeffrey G. Jarvik

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Objective: To estimate the prevalence of co-occurring pain sites among older adults with persistent back pain and associations of multisite pain with longitudinal outcomes. Design: Secondary analysis of a cohort study. Setting: Three integrated health systems in the United States. Subjects: Eight hundred ninety-nine older adults with persistent back pain. Methods: Participants reported pain in the following sites: stomach, arms/legs/joints, headaches, neck, pelvis/groin, and widespread pain. Over 18 months, we measured back-related disability (Roland Morris, scored 0-24), pain intensity (11-point numerical rating scale), health-related quality of life (EuroQol-5D [EQ-5D], utility from 0-1), and falls in the past three weeks. We used mixed-effects models to test the association of number and type of pain sites with each outcome. Results: Nearly all (N = 839, 93%) respondents reported at least one additional pain site. There were 216 (24%) with one additional site and 623 (69%) with multiple additional sites. The most prevalent comorbid pain site was the arms/legs/joints (N = 801, 89.1%). Adjusted mixed-effects models showed that for every additional pain site, RMDQ worsened by 0.65 points (95% confidence interval [CI] = 0.43 to 0.86), back pain intensity increased by 0.14 points (95% CI = 0.07 to 0.22), EQ-5D worsened by 0.012 points (95% CI = -0.018 to -0.006), and the odds of falling increased by 27% (odds ratio = 1.27, 95% CI = 1.12 to 1.43). Some specific pain sites (extremity pain, widespread pain, and pelvis/groin pain) were associated with greater long-term disability. Conclusions: Multisite pain is common among older adults with persistent back pain. Number of pain sites was associated with all outcomes; individual pain sites were less consistently associated with outcomes.

Original languageEnglish (US)
Pages (from-to)1898-1906
Number of pages9
JournalPain Medicine (United States)
Issue number10
StatePublished - Oct 1 2019


  • Back Pain
  • Long-term Outcomes
  • Multisite Pain
  • Older Adults
  • Widespread Pain

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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