title: Progression of low back and lower extremity pain in a cohort of patients with achondroplasia.
abstract: OBJECTIVE
  The aim of this study was to assess the natural history of pain associated with spinal stenosis in individuals with achondroplasia and to characterize pain patterns and associated functional and psychological effects.
  
  
  METHODS
  The authors measured pain severity, spatial distribution of pain, functional disability, psychological distress, physical symptoms other than pain, and healthcare utilization in 181 individuals with achondroplasia. They also assessed low back and/or lower extremity pain at the initial visit and 1-year follow-up via self-rated patient questionnaires, calculated composite scores from responses via component analyses, and used repeated measures linear regression analyses for score changes (significance, p < or = 0.05).
  
  
  RESULTS
  At the follow-up, back pain severity was unchanged. Patients reported significant progression of pain toward involvement of the lower extremities and significant increases in lower extremity pain severity overall. There were also significant increases in healthcare utilization overall. Compared with patients with back pain only, those with back pain and proximal or distal leg pain had higher self-rated pain severity; higher functional disability; and more bowel and bladder dysfunction symptoms, sleep disturbances, extremity numbness, and psychological distress.
  
  
  CONCLUSIONS
  Individuals with achondroplasia and symptomatic spinal stenosis often experience back pain, which may progress to lower extremity pain and debilitating consequences. A more thorough understanding of the progression of spatial pain characteristics and pain severity may aid clinical decision making regarding the optimal timing for intervention.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland 21224-2780, USA. ehenze1@jhmi.edu
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ain
authors.forename: Madeel A
authors.initials: MA
authors.lastname: Abdullah
authors.forename: Beverlie L
authors.initials: BL
authors.lastname: Ting
authors.forename: Richard L
authors.initials: RL
authors.lastname: Skolasky
authors.forename: Emily Streyer
authors.initials: ES
authors.lastname: Carlisle
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Schkrohowsky
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
mesh_terms: D000130:Achondroplasia / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg; D016014:Linear Models; D017116:Low Back Pain / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D010342:Patient Acceptance of Health Care; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult