Abstract
Back pain is common in the elderly. Most back pain is uncomplicated but identifying back pain due to serious systemic disease is essential. History and physical exam are critical to this distinction and guide further diagnostic evaluation. There are numerous treatments available for acute and chronic back pain, yet there are special considerations when treating the elderly. Treatment is comprehensive with pharmacotherapy, physical therapy, and alternative methods. Pharmacologic therapy for back pain is targeted at reducing inflammation and providing analgesia. Physical therapy is a necessary part of any treatment plan. Non-pharmacologic treatments are broad in scope and consist of activity-based modalities and alternative therapies. Acute back pain generally has a good prognosis, while chronic back pain can be associated with significant morbidity. This update will review the epidemiology, pathophysiology, evaluation, and treatment of back pain with a particular emphasis on issues unique to the geriatric population.
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References
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Breasted JH. The Edwin Smith Surgical Papyrus. The University of Chicago Press. 1930;2 volumes.
Allan DB, Waddell G. An historical perspective on low back pain and disability. Acta Orthop Scand Suppl. 1989;234:1–23. provides a comprehensive and thorough review of the history of back pain.
Weiner DK, Haggerty CL, Kritchevsky SB, Harris T, Simonsick EM, Nevitt M, et al. How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future. Pain Med. 2003;4(4):311–20.
Jacobs JM, Hammerman-Rozenberg R, Cohen A, Stessman J. Chronic back pain among the elderly: prevalence, associations, and predictors. Spine. 2006;31(7):E203–7.
Reid MC, Williams CS, Gill TM. Back pain and decline in lower extremity physical function among community-dwelling older persons. J Gerontol A Biol Sci Med Sci. 2005;60(6):793–7.
Sha MC, Callahan CM, Counsell SR, Westmoreland GR, Stump TE, Kroenke K. Physical symptoms as a predictor of health care use and mortality among older adults. Am J Med. 2005;118(3):301–6.
Chen Q, Hayman LL, Shmerling RH, Bean JF, Leveille SG. Characteristics of chronic pain associated with sleep difficulty in older adults: the maintenance of balance, independent living, intellect, and zest in the elderly (MOBILIZE) Boston study. J Am Geriatr Soc. 2011;59(8):1385–92.
Muraki S, Akune T, Oka H, En-Yo Y, Yoshida M, Nakamura K, et al. Prevalence of falls and the association with knee osteoarthritis and lumbar spondylosis as well as knee and lower back pain in Japanese men and women. Arthritis Care Res. 2011;63(10):1425–31.
Muraki S, Akune T, Oka H, En-Yo Y, Yoshida M, Saika A, et al. Health-related quality of life in subjects with low back pain and knee pain in a population-based cohort study of Japanese men: the research on osteoarthritis against disability study. Spine. 2011;36(16):1312–9.
Hubscher M, Vogt L, Schmidt K, Fink M, Banzer W. Perceived pain, fear of falling and physical function in women with osteoporosis. Gait Posture. 2010;32(3):383–5.
Basler HD, Luckmann J, Wolf U, Quint S. Fear-avoidance beliefs, physical activity, and disability in elderly individuals with chronic low back pain and healthy controls. Clin J Pain. 2008;24(7):604–10.
Reid MC, Williams CS, Concato J, Tinetti ME, Gill TM. Depressive symptoms as a risk factor for disabling back pain in community-dwelling older persons. J Am Geriatr Soc. 2003;51(12):1710–7.
Meyer T, Cooper J, Raspe H. Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Spine. 2007;32(21):2380–6.
Zhu K, Devine A, Dick IM, Prince RL. Association of back pain frequency with mortality, coronary heart events, mobility, and quality of life in elderly women. Spine. 2007;32(18):2012–8.
Andersen RE, Crespo CJ, Bartlett SJ, Bathon JM, Fontaine KR. Relationship between body weight gain and significant knee, hip, and back pain in older Americans. Obes Res. 2003;11(10):1159–62.
Muraki S, Oka H, Akune T, Mabuchi A, En-Yo Y, Yoshida M, et al. Prevalence of radiographic lumbar spondylosis and its association with low back pain in elderly subjects of population-based cohorts: the ROAD study. Ann Rheum Dis. 2009;68(9):1401–6.
Denard PJ, Holton KF, Miller J, Fink HA, Kado DM, Marshall LM, et al. Back pain, neurogenic symptoms, and physical function in relation to spondylolisthesis among elderly men. Spine J Off J North American Spine Soc. 2010;10(10):865–73.
Jarvik JG, Comstock BA, Bresnahan BW, Nedeljkovic SS, Nerenz DR, Bauer Z, et al. Study protocol: the back pain outcomes using longitudinal data (BOLD) registry. BMC Musculoskelet Disord. 2012;13:64. development of a resource for ongoing research on back pain.
Beattie PF. Current understanding of lumbar intervertebral disc degeneration: a review with emphasis upon etiology, pathophysiology, and lumbar magnetic resonance imaging findings. J Orthop Sports Phys Ther. 2008;38(6):329–40.
Battie MC, Videman T, Levalahti E, Gill K, Kaprio J. Genetic and environmental effects on disc degeneration by phenotype and spinal level: a multivariate twin study. Spine. 2008;33(25):2801–8.
Galbraith JG, Butler JS, Blake SP, Kelleher G. Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED. Am J Emerg Med. 2011;29(3):359 e5–6.
Lyders EM, Whitlow CT, Baker MD, Morris PP. Imaging and treatment of sacral insufficiency fractures. AJNR Am J Neuroradiol. 2010;31(2):201–10.
Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010;6, CD007612.
Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008;1, CD000396.
Heard KJ, Green JL, Dart RC. Serum alanine aminotransferase elevation during 10 days of acetaminophen use in nondrinkers. Pharmacotherapy. 2010;30(8):818–22.
Heard K, Green JL, Anderson V, Bucher-Bartelson B, Dart RC. A randomized, placebo-controlled trial to determine the course of aminotransferase elevation during prolonged acetaminophen administration. BMC Pharmacol Toxicol. 2014;15:39. trial evaluating risk of acetaminophen use and serum transaminase levels.
van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. 2003;2, CD004252.
Papaleontiou M, Henderson Jr CR, Turner BJ, Moore AA, Olkhovskaya Y, Amanfo L, et al. Outcomes associated with opioid use in the treatment of chronic noncancer pain in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2010;58(7):1353–69.
Reid MC, Henderson Jr CR, Papaleontiou M, Amanfo L, Olkhovskaya Y, Moore AA, et al. Characteristics of older adults receiving opioids in primary care: treatment duration and outcomes. Pain Med. 2010;11(7):1063–71.
American Geriatrics Society Beers Criteria Update Expert P. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31. excellent resource for medications which may be harmful in the elderly.
Balthazard P, de Goumoens P, Rivier G, Demeulenaere P, Ballabeni P, Deriaz O. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2012;13:162.
Ferreira PH, Ferreira ML, Maher CG, Refshauge KM, Latimer J, Adams RD. he therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Phys Ther. 2013;93(4):470–8. highlights importance of clinician-patient relationship in back pain outcomes.
Meng CF, Wang D, Ngeow J, Lao L, Peterson M, Paget S. Acupuncture for chronic low back pain in older patients: a randomized, controlled trial. Rheumatology. 2003;42(12):1508–17.
Killinger LZ. Chiropractic and geriatrics: a review of the training, role, and scope of chiropractic in caring for aging patients. Clin Geriatr Med. 2004;20(2):223–35.
Pearson A, Lurie J, Tosteson T, Zhao W, Abdu W, Weinstein JN. Who should have surgery for spinal stenosis? Treatment effect predictors in SPORT. Spine. 2012;37(21):1791–802. overview of considerations for surgical referral.
Adogwa O, Carr RK, Kudyba K, Karikari I, Bagley CA, Gokaslan ZL, et al. Revision lumbar surgery in elderly patients with symptomatic pseudarthrosis, adjacent-segment disease, or same-level recurrent stenosis. Part 1. Two-year outcomes and clinical efficacy: clinical article. Journal of neurosurgery. Spine. 2013;18(2):139–46.
Issack PS, Cunningham ME, Pumberger M, Hughes AP, Cammisa Jr FP. Degenerative lumbar spinal stenosis: evaluation and management. J Am Acad Orthop Surg. 2012;20(8):527–35.
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Christina M. Ulane declares that she has no conflict of interest.
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This article is part of the Topical Collection on Neurology of Aging
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Ulane, C.M. Evaluation and Management of Back Pain in the Elderly. Curr Geri Rep 4, 117–123 (2015). https://doi.org/10.1007/s13670-015-0122-0
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DOI: https://doi.org/10.1007/s13670-015-0122-0