Evidence map›Paper›PMID 40772830›Full record

ArticleEuropean journal of pain (London, England)2025

The Longitudinal Association Between Chronic Back Pain and Cognitive Decline in Older Adults With Mediation Analysis: An Analysis of Four Population-Based Databases.

Frank F Huang, Yuying Zhang, Lian Liu, Chun Liang Hsu, Raymond Chung, Wanming Wu, Daniel K Y Zheng, Zihui Xiong, Jeremy R Chang, Yongping Zheng and 6 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European journal of pain (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Frank F HuangDepartment of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.ORCID https://orcid.org/0000-0002-9195-7718
Yuying ZhangSchool of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China.
Lian LiuAcupuncture, Moxibustion, and Rehabilitation Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
Chun Liang HsuDepartment of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Raymond ChungDepartment of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Wanming WuAcupuncture, Moxibustion, and Rehabilitation Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
Daniel K Y ZhengDepartment of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Zihui XiongDepartment of Hepatobiliary Surgery, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China.
Jeremy R ChangDepartment of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Yongping ZhengDepartment of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
Manuela L FerreiraThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
Paulo H FerreiraFaculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
F U AmyDepartment of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Fadi A L ZoubiDepartment of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Hio Teng LeongDepartment of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Arnold Y L WongDepartment of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.ORCID https://orcid.org/0000-0002-5911-5756

Funding

HRS Yrs29-34: Y33 SSA CoFundingU01AG009740 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Jessica Faul, KENNETH M LANGA · 1990 to 2026
$555.8M
NIA NIH HHS U01 AG009740
6 · The paper itself

Abstract

backgroundWhile studies suggest chronic back pain (CBP) may heighten accelerated cognitive decline risk in older adults, no multinational research has comprehensively examined this significant public health concern alongside healthy lifestyles' potential impact.

methodsData from 18,558 individuals across 17 countries (China, England, Europe, USA) were extracted from four databases (2010-2023; median follow-up: 8.4 years). Associations between CBP and memory-related diseases (MDs), cognitive function performance metrics (e.g., numeracy, orientation, immediate word recall, delayed word recall memory, and an overall cognitive score combining these elements), and subjective cognitive decline (SCD) were analysed using linear mixed-effects models and conducting mediation analysis through Structural Equation Modelling, adjusting for confounders.

resultsCBP significantly elevated MD and SCD risks in the USA (MDs: OR 1.03 to 1.47; SCD: OR 1.03 to 1.04) and Europe (MDs: HR 1.18 to 2.15; SCD: HR 1.01 to 1.03). Pooled meta-analyses confirmed significant but weak associations: MDs (OR = 1.35, 95% CI 1.03 to 1.68), delayed recall (β = -0.05, 95% CI -0.09 to -0.02), and SCD (HR = 1.02, 95% CI 1.00 to 1.03). Mediation analyses identified alcohol intake as exacerbating cognitive decline, while smoking cessation, physical activity, and sleep (7-9 h) reduced risks in older adults with CBP.

conclusionsCBP heightens accelerated cognitive decline risks in older adults, mediated by modifiable lifestyle factors. These findings emphasise cognitive monitoring and tailored lifestyle interventions, particularly smoking cessation, activity promotion, and sleep optimisation in older adults with CBP. Multidimensional approaches integrating physical and behavioural strategies are critical to mitigating cognitive impairment in this population. SIGNIFICANCE STATEMENT: CBP increases the risk of cognitive decline in older adults, underscoring the importance of preventing cognitive decline in this population. Public health initiatives should prioritise interventions that target CBP management and lifestyle modifications to mitigate the risk of pain and cognitive decline.

Indexed as

Back PainChronic PainCognitive DysfunctionAgedAged, 80 and overChinaDatabases, FactualEnglandEuropeFemaleHumansLongitudinal StudiesMaleMediation AnalysisMiddle AgedUnited Stateschronic back paincognitive declinelongitudinal studymediation analysispopulation‐based databases

Identifiers

PMID40772830
PMCPMC12330781

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.