[Back pain, pain therapy and satisfaction with therapy--analyses in a cohort of elderly primary health care patients (getABI)]

Introduction: Back pain can affect quality of life and independence of elderly people. The goal of this study was to determine the prevalence of back pain in a cohort of elderly primary health care patients, as well as to analyse pain therapy and level of satisfaction with therapy.

Methods: In a monitored prospective cohort study (German epidemiological trial on ankle brachial index, getABI), 6 880 unselected patients aged 65 years and above have been followed up by 344 representative primary care physicians in Germany since October 2001. In the 5-year follow-up, 2 120 patients (median age 76; 70-94 years; 53.7% women) were interviewed by telephone about location and intensity of pain during the past 3 months, about impairment due to pain, about pain therapy and satisfaction with therapy.

Results: Of the 2 095 patients who answered the questions on pain, 803 (38.3%) had suffered from pain of the upper and/or lower back within the past 3 months. The prevalence of back pain was higher in female than in male patients (45.0% vs. 30.6%; p<0.05). In about half of the men and half of the women with back pain, the back was also the main pain region. This subsample (n=409) with the back as main pain region (BMP) was analysed in more detail. The mean "von Korff intensity score" (scale 0-100) was 46.5±19.9, the mean "von Korff impairment score" (scale 0-100) was 23.6±23.0. Women reported a higher mean intensity of back pain than men (48.8±20.0 vs. 42.4±19.3; p<0.05) and complained about a higher pain-related impairment (26.2±23.5 vs. 19.2±21.5; p<0.05). Of all BMP patients, 253 (61.9%) visited a physician (at least once) during the past 3 months due to pain. The treatments most frequently applied (multiple answers permitted) were: oral medication (62.5%), injections (38.6%), and physiotherapy (35.9%). Patients (n=224) were asked to rate the therapy on a scale from 1 to 6 (1 being the highest grade). The mean rating was 3.1±1.4. 36.8% were not satisfied with pain relief. 61.4% wished for a considerable improvement of their pain therapy.

Conclusion: The prevalence of back pain in elderly people is high and leads to functional limitations. As a consequence of the rather low mean satisfaction with pain therapy, future studies on back pain therapy should include an assessment of patient preferences and satisfaction with therapy. It remains questionable, if the current medical care for elderly people with back pain complies with the latest guidelines that demand for multimodal therapy.