The impact of low back pain and disability on frailty levels in older women: longitudinal data from the BACE-Brazil cohort.

METHODS: This is a longitudinal observational study with a convenience subsample from the international Back Complaints in the Elders (BACE)-Brazil. Frailty was assessed by researchers at baseline, 6 and 12 months according to the Frailty Phenotype. Pain was assessed using a Numerical Pain Scale (NPS). Disability was assessed using the Roland Morris Disability Questionnaire. RESULTS: A total of 155 older women (70.4 ± 5.4 years) participated. Follow-up for 6 and 12 months in this study was associated with a change of older women to worse frailty levels (OR = 2.83, 95% CI 1.98-4.67; p < 0.01). A significant association was observed between greater pain intensity and the transition of the older women through the frailty levels (ß = - 0.73; p < 0.01) when inserting the pain variable at baseline of the statistical model. Older women who reported greater pain intensity worsened their frailty level. The same happened when the disability variable was inserted in the model (ß = - 0.74; p < 0.01). The criteria proposed by Fried et al. were able to identify frailty throughout the follow-up and no prevalence of any item. CONCLUSIONS: In older women, relevant factors such as pain and disability are closely linked to the frailty phenomenon. Thus, the frailty syndrome must be assessed, monitored and treated in relation to the individualities of older adults, as those with back pain and greater disabilities are more susceptible to frailty.

Brain-derived neurotrophic factor plasma levels are increased in older women after an acute episode of low back pain.

BACKGROUND: Low back pain (LBP) is a growing public health problem in old age, and it is associated with disabling pain and depressive disorders. We compared brain-derived neurotrophic factor (BDNF) plasma levels, a key neurotrophin in pain modulation, between older women after an acute episode of LBP and age-matched pain-free controls, and investigated potential differences in BDNF levels between controls and LBP subgroups based on pain severity, presence of depressive symptoms and use of analgesic and antidepressant drugs. METHODS: A total of 221 participants (154 with LBP and 67 pain-free) were studied. A comprehensive assessment of sociodemographic and clinical variables was conducted including pain severity (11-point NRS), depressive symptoms (GDS-15), age, body mass index, physical activity and total number of comorbidities and medications in use. RESULTS: BDNF levels in LBP group were significantly higher than controls (7515.9±3021.2; Md=7116.0 vs 6331.8±3364.0; Md=5897.5pg/mL, P=0.005). LBP subgroups exhibited higher BDNF levels than controls, regardless of pain severity, presence of depressive symptoms and use of analgesic drugs. BDNF levels were significantly higher in LBP subgroup without use of antidepressant drugs compared to both controls and LBP subgroup with use of antidepressant drugs. DISCUSSION: This study provides evidence that older women with acute low back pain exhibit higher BDNF plasma levels compared to pain-free controls. Subgroup comparisons suggest that use of pain-relief drugs may influence BDNF levels. The study results offer a novel target for research on mechanisms of back pain in older adults.

Association Between the Plasma Levels of Mediators of Inflammation With Pain and Disability in the Elderly With Acute Low Back Pain: Data From the Back Complaints in the Elders (BACE)-Brazil Study.

STUDY DESIGN: Cross-sectional study with subsample of elderly women with acute low back pain (LBP), from Back Complaints in the Elders-Brazil (BACE-Brazil) OBJECTIVE: To investigate the association between plasma levels of mediators of inflammation (interleukin-1 beta (IL-1ß), IL-6, tumor necrosis factor alpha (TNF-α), and soluble TNF receptor 1 (sTNF-R1)) with pain and disability experienced by elderly women with acute LBP. SUMMARY OF BACKGROUND DATA: Among the elderly, LBP is a complaint of great importance and can lead to disability. Inflammatory cytokines are elevated in painful conditions, and may promote pain. METHODS: We included 155 community-dwelling elderly women (age ≥ 65 yr), who presented with a new (acute) episode of LBP. Enzyme-linked immunosorbent assays were used to measure TNF-α, sTNF-R1, IL-1ß, and IL-6. Disability was assessed using the Roland Morris Disability Questionnaire; pain was assessed using the McGill Pain Questionnaire. Linear regression models were fit with each pain and disability outcome as dependent variables: Present Pain Intensity; Qualities of pain; Severity of pain in the last week; LBP frequency and disability. RESULTS: Depressive symptoms and IL-6 were associated and explained 20.9% of "qualities of pain" variability. TNF-α, sTNFR1, education, body mass index, and depressive symptoms explained 8.4% of "Severity of pain in the past week" variability. TNF-α, education, BMI, depressive symptoms, present pain intensity, qualities of pain, and LBP frequency explained 48.6% of "disability." No associations between inflammatory cytokines and "present pain intensity" and "LBP frequency" were found. CONCLUSION: Our results demonstrate associations between inflammatory markers (TNF-α and sTNFR1) and pain severity, IL-6 was associated with the qualities of pain, and TNF-α was also associated with disability. These inflammatory mediators represent new markers to be considered in the assessment and treatment of elderly patients with LBP. LEVEL OF EVIDENCE: 5.

Poor correlation between handgrip strength and isokinetic performance of knee flexor and extensor muscles in community-dwelling elderly women.

AIM: To investigate the correlation between handgrip strength and performance of knee flexor and extensor muscles determined using an isokinetic dynamometer in community-dwelling elderly women. METHODS: This was a cross-sectional study. Sample selection for the study was made by convenience, and 221 (71.07 ± 4.93 years) community-dwelling elderly women were included. Knee flexor and extensor muscle performance was measured using an isokinetic dynamometer Biodex System 3 Pro. The isokinetic variables chosen for analysis were peak torque, peak torque/bodyweight, total work/bodyweight, total work, average power, and agonist/antagonist ratio at the angular velocities of 60°/s and 180°/s. Assessment of handgrip strength was carried out using the Jamar dynamometer. Spearman's correlation coefficient was calculated to identify intervariable correlations. RESULTS: Only knee flexor peak torque (60°/s) and average power (60°/s), and knee extensor peak torque (180°/s) and total work (180°/s) were significantly (P < 0.05), yet poorly, correlated with handgrip strength (r < 0.30). CONCLUSION: The majority of analyses did not show any correlation between variables assessed by isokinetic dynamometer and handgrip dynamometer. Caution is required when generalizing handgrip strength as a predictor of global muscle strength in community-dwelling elderly women.

TNF-α, IL6, and IL10 polymorphisms and the effect of physical exercise on inflammatory parameters and physical performance in elderly women.

High levels of inflammatory mediators are associated with reduced physical capabilities and muscle function in the elderly. Single nucleotide polymorphisms (SNPs) may affect the expression and synthesis of these molecules, thus influencing the intensity of the inflammatory response and susceptibility to certain diseases. Physical exercise may attenuate age-related chronic inflammation and improve physical performance. This study evaluated the interaction between the SNP rs1800629 in TNF-α, rs1800795 in IL6, and rs1800896 in IL10 and the effect of physical exercise on physical performance and inflammation in elderly women. There was a significant interaction between rs1800629 and the effect of exercise on physical performance and between the combined 3-SNP genotype and changes in physical performance in response to exercise. These SNPs did not influence the effect of exercise on inflammatory parameters. Elderly women with a combination of genotypes associated with an anti-inflammatory profile (low TNF-α and IL-6 production, high IL-10 production) showed better physical performance independent of exercise modality, evidence of an interactive influence of genetic and environmental factors on improving physical performance in elderly women.

Interleukin-6 plasma levels and socioeconomic status in Brazilian elderly community-dwelling women.

Aging is related to a chronic increase in inflammatory cytokines. Adverse socioeconomic conditions are associated with increased plasma levels of these molecules, especially interleukin (IL)-6. Considering the differential profile of elderly Brazilians regarding their socioeconomic and cultural aspects, the objectives of this study were: to assess the correlation and differences between levels of IL-6 and socioeconomic status (education and income) in elderly women. IL-6 levels were measured using ELISA. The Spearman test was used to determine the correlation between IL-6 and socioeconomic status, and the Kruskal-Wallis and Mann-Whitney tests for cytokine level differences across education and income. IL-6 showed a significant inverse correlation with education (r = -0.205, p = 0.014) and income (r = -0.185, p = 0.028). Differences in IL-6 levels were registered across the education variables. The results corroborate evidence that low socioeconomic status is related to higher IL-6 plasma levels in elderly women.