Severe Neck and Low Back Pain Predicts Severe Pain 5 Years Later in Older Men: A Cohort Study

Henrik Damm,1 Björn E Rosengren,1 Lars Jehpsson,1 Claes Ohlsson,2,3 Eva L Ribom,4 Dan Mellström,5 Magnus K Karlsson1 1Orthopedics, Faculty of Medicine, Departments of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden; 2Sahlgrenska Osteoporosis Centre, Center for Bone Research, Departments of Internal Medicine and Geriatrics, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden; 3Department of Drug Treatment, Region Västra Götaland, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden; 4Section of Orthopaedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; 5Departments of Internal Medicine and Geriatrics, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, SwedenCorrespondence: Henrik Damm, Department of Orthopaedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, SE-205 02, Sweden, Tel +46 40331000, Email henrik.damm@med.lu.sePurpose: To describe the prevalence of neck pain (NP) and low back pain (LBP) of varying severity in older community-dwelling men, identify associated factors, and evaluate whether prevalent NP/LBP are risk factors for experiencing pain 5 years later.Patients and Methods: MrOS Sweden is a prospective observational study that included 3014 community-dwelling men aged 69– 81 years, of whom 1962 attended a 5-year follow-up. NP/LBP were assessed based on 1-year prevalence (yes/no), pain severity (none, mild, moderate, severe), and the presence of radicular pain with or without motor deficits (yes/no), at both baseline and follow-up.Results: At baseline, the 1-year prevalence for having either NP, LBP, or both was 55%. The 1-year prevalence for NP was 29% and for LBP 45%. Among men with NP, 18% reported severe pain, while 17% of men with LBP reported severe pain. Men with NP at baseline had a relative risk (RR) of 4.0 (95% CI: 3.4– 4.6) for reporting NP 5 years later, compared to men without NP at baseline. Men with severe NP had an RR of 10.7 (95% CI: 7.5– 15.1) for reporting severe NP 5 years later, compared to men without severe NP at baseline. The corresponding RRs for LBP were 2.8 (95% CI: 2.5– 3.1) and 6.5 (95% CI: 4.9– 8.6). Poor self-rated health and dizziness were associated with NP/LBP at both time points, while smoking was associated with lower risk of NP.Conclusion: More than half of community-dwelling men aged 69– 81 experience pain in the spinal region during a year (nearly one-third NP and just below half LBP). The majority experience only mild to moderate pain. Baseline pain, especially severe pain, strongly predicts pain 5 years later, and associated factors may help identify high-risk groups suitable for targeted interventions.Keywords: ageing, epidemiology, musculoskeletal pain, population-based, radiculopathy, motoric symptoms

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