Advertisement

Management of Back Pain in Older Patients

  • Jennifer Truchot
  • Jean Laganier
Chapter

Abstract

The prevalence of pain in older patients and the consequences of undertreated pain pose a substantial burden to the patients, their family, and society. Low back pain (LBP) is a very common reason for visiting an emergency department (ED). The diagnosis of LBP in older patients in the ED should be based on careful history taking and physical findings. LBP is a consequence of age-related changes in the structure of the lumbar spine. They can be associated with the patient’s lifestyle. Osteoarthritis is the first cause of LBP in older patients, before inflammatory rheumatism. Diagnosis pitfalls among older patients are frequent and should always be evoked in the ED. Any acute behavior change in older patients must arise the suspicion of acute pain and therefore also LBP.

Acetaminophen should be considered as first-line treatment for the management of LBP because of a demonstrated efficacy and a good safety profile. Opioids are now more widely accepted for treating older adults with persistent pain. Non-pharmacologic and essential pain management treatments exist including physical exercise.

Keywords

Low back pain Older patients Disability Functional performance Pain assessment Exercise Lumbar degenerative disease 

References

  1. 1.
    Jakobsson U, Klevsgard R, Westergren A, Rahm HI (2003) Old people in pain: a comparative study. J Pain Symptom Manag 26:625–636CrossRefGoogle Scholar
  2. 2.
    D’Astolfo CJ, Humphreys BK (2006) A record review of reported musculoskeletal pain in Ontario long-term facility. BMC Geriatr 6(1):5. doi:10.1186/1471-2318-6-5 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Edmond SL, Felson DT (2000) Prevalence of back symptoms in elders. J Rheumatol 27:220–225PubMedGoogle Scholar
  4. 4.
    Barkin RL, Barkin SJ, Barkin DS (2005) Perception, assessment, treatment, and management of pain in the elderly. Clin Geriatr Med 21:465–490CrossRefGoogle Scholar
  5. 5.
    Thomas E, Peat G, Harris L, Wilkie R, Croft PR (2004) The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP). Pain 110(1–2):361–368CrossRefGoogle Scholar
  6. 6.
    Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain? JAMA 268:760–765CrossRefGoogle Scholar
  7. 7.
    Deyo RA, Weinstein JN (2001) Low back pain. N Engl J Med 344:363–370CrossRefGoogle Scholar
  8. 8.
    Hartvigsen J, Frederiksen H, Christensen K (2006) Back and neck pain in seniors—prevalence and impact. Eur Spine J 15(6):802–806. doi:10.1007/s00586-005-0983-6 CrossRefPubMedGoogle Scholar
  9. 9.
    Bair MJ, Robinson RL, Katon W, Kroenke K (2003) Depression and pain comorbidity: a literature review. Arch Intern Med 163(20):2433–2445CrossRefGoogle Scholar
  10. 10.
    Fishbain DA, Cutler R, Rosomoff HL, Rosomoff RS (1997) Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain 13(2):116–137CrossRefGoogle Scholar
  11. 11.
    Bosley BN, Weiner DK, Rudy TE, Granieri E (2004) Is chronic nonmalignant pain associated with decreased appetite in older adults? Preliminary evidence. J Am Geriatr Soc 52(2):247–251CrossRefGoogle Scholar
  12. 12.
    Ancoli-Israel S, Soares CN, Gaeta R, Benca RM (2004) Insomnia in special populations: effects of aging, menopause, chronic pain, and depression. Postgrad Med 116:33–47. doi:10.3810/pgm.12.2004.suppl38.260 CrossRefPubMedGoogle Scholar
  13. 13.
    Cooper JK, Kohlmann T (2001) Factors associated with health status of older Americans. Age Ageing 30(6):495–501CrossRefGoogle Scholar
  14. 14.
    Bressler HB, Keyes WJ, Rochon PA, Badley E (1999) The prevalence of low back pain in the elderly. A systematic review of the literature. Spine 24(17):1813–1819CrossRefGoogle Scholar
  15. 15.
    Waterman BR, Belmont PJ Jr, Schoenfeld AJ (2012) Low back pain in the United States: incidence and risk factors for presentation in the emergency setting. Spine J 12:63–70CrossRefGoogle Scholar
  16. 16.
    Ando M, Yamamoto H et al (1986) J West Jpn Res Soc Spine 12(1):172–175Google Scholar
  17. 17.
    Keim HA, Kirkaldy-Willis WH (1980) Low back pain. Clin Symp 32(6):1–35PubMedGoogle Scholar
  18. 18.
    Corwell BN (2010) The emergency department evaluation, management, and treatment of back pain. Emerg Med Clin North Am 28(4):811–39CrossRefGoogle Scholar
  19. 19.
    Della-Giustina DA (1999) Emergency department evaluation and treatment of back pain. Emerg Med Clin North Am 17:877–893CrossRefGoogle Scholar
  20. 20.
    Hazzard WR, Halter JB (2009) Hazzard’s geriatric medicine and gerontology. McGraw-Hill Medical, New York, p 1634Google Scholar
  21. 21.
    Sauter S, Hadler NM (2000) Back pain in elderly people. In: Evans JG, Williams TF, Beattie BL et al (eds) Oxford textbook of geriatric medicine, 2nd edn. University of Oxford Press, Oxford, pp 391–397Google Scholar
  22. 22.
    Winters ME, Kluetz P, Zilberstein J (2006) Back pain emergencies. Med Clin North Am 90:505–523CrossRefGoogle Scholar
  23. 23.
    Laiho K, Tuomilehto J, Tilvis R (2001) Prevalence of rheumatoid arthritis and musculoskeletal diseases in the elderly population. Rheumatol Int 20:85–87CrossRefGoogle Scholar
  24. 24.
    Hadjistavropoulos T, Herr K, Turk DC, Fine PG, Dworkin RH, Helme R, Jackson K, Parmelee PA, Rudy TE, Lynn Beattie B, Chibnall JT, Craig KD, Ferrell B, Ferrell B, Fillingim RB, Gagliese L, Gallagher R, Gibson SJ, Harrison EL, Katz B, Keefe FJ, Lieber SJ, Lussier D, Schmader KE, Tait RC, Weiner DK, Williams J (2007) An interdisciplinary expert consensus statement on assessment of pain in older persons. Clin J Pain 23:S1–S43CrossRefGoogle Scholar
  25. 25.
    Herr K (2005) Pain assessment in the older adult with verbal communication skills. In: Gibson SJ, Weiner DK (eds) Pain in older persons, vol 35. IASP Press, Seattle, pp 111–133Google Scholar
  26. 26.
    Weiner D, Pieper C et al (1996) Pain measurement in elders with chronic low back pain: traditional and alternative approaches. Pain 67:461–467CrossRefGoogle Scholar
  27. 27.
    Edmond SL, Felson DT (2003) Function and back symptoms in older adults. J Am Geriatr Soc 51:1702–1709CrossRefGoogle Scholar
  28. 28.
    Leveille SG, Guralnik JM, Hochberg M et al (1999) Low back pain and disability in older women: independent association with difficulty but not inability to perform daily activities. J Gerontol 54A:M487–M493CrossRefGoogle Scholar
  29. 29.
    Weiner DK, Haggerty CL, Kritchevsky SB et al (2003) 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 4:311–320CrossRefGoogle Scholar
  30. 30.
    Isaacs DM, Marinac J, Sun C (2004) Radiograph use in low back pain: a United States emergency department database (2014-01-16) analysis. J Emerg Med 26:37–45CrossRefGoogle Scholar
  31. 31.
    Weiner AL, MacKenzie RS (1999) Utilization of lumbosacral spine radiographs for the evaluation of low back pain in the emergency department. J Emerg Med 17:229–233CrossRefGoogle Scholar
  32. 32.
    Miller JC, Palmer WE, Mansfield FL et al (2006) When is imaging helpful for patients with back pain? J Am Coll Radiol 3:957–960CrossRefGoogle Scholar
  33. 33.
    Schlemmer E, Mitchiner JC, Brown M, Wasilevich E (2015) Imaging during low back pain ED visits: a claims-based descriptive analysis. Am J Emerg Med 33(3):414–418. doi:10.1016/j.ajem.2014.12.060. Epub 2014 Dec 31CrossRefPubMedGoogle Scholar
  34. 34.
    Hartikainen SA, Mantyselka PT, Louhivuori-Laako KA, Sulkava RO (2005) Balancing pain and analgesic treatment in the home-dwelling elderly. Ann Pharmacother 39:11–16CrossRefGoogle Scholar
  35. 35.
    McCarberg BH (2007) Rheumatic diseases in the elderly: dealing with rheumatic pain in extended care facilities. Rheum Dis Clin N Am 33:87–108CrossRefGoogle Scholar
  36. 36.
    Leland JY (1999) Chronic pain: primary care treatment of the older patient. Geriatrics 54:33–37Google Scholar
  37. 37.
    AGS Panel on Persistent Pain in Older Persons (2002) The management of persistent pain in older persons. J Am Geriatr Soc 50(6 Suppl):S205–S224Google Scholar
  38. 38.
    Cavalieri TA (2002) Pain management in the elderly. J Am Osteopath Assoc 102:481–485PubMedGoogle Scholar
  39. 39.
    Stucki G, Johannesson M, Liang MH (1996) Use of misoprostol in the elderly: is the expense justified? Drugs Aging 8:84–88CrossRefGoogle Scholar
  40. 40.
    Greenberger NJ (1997) Update in gastroenterology. Ann Intern Med 127:827–834CrossRefGoogle Scholar
  41. 41.
    Topol EJ (2004) Failing the public health—rofecoxib, Merck, and the FDA. N Engl J Med 351(17):1707–1709CrossRefGoogle Scholar
  42. 42.
    Pergolizzi J, Böger RH, Budd K et al (2008) Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 8:287–313CrossRefGoogle Scholar
  43. 43.
    Podichetty VK, Mazaneck D, Biscup RS (2003) Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention. Postgrad Med J 79:627–633CrossRefGoogle Scholar
  44. 44.
    Balakrishnamoorthy R, Horgan I, Perez S, Steele MC, Keijzers GB (2015) Does a single dose of intravenous dexamethasone reduce Symptoms in Emergency department patients with low Back pain and RAdiculopathy (SEBRA)? A double-blind randomised controlled trial. Emerg Med J 32(7):525–530. doi:10.1136/emermed-2013-203490. Epub 2014 Aug 13CrossRefPubMedGoogle Scholar
  45. 45.
    Jacox A, Carr DB, Payne R, Berde CB, Breitbart W, Cain JM et al (1994) Management of cancer pain. Clinical practice guideline no. 9. AHCPR publication no. 94-0592. Agency for Health Care Policy and Research, US Department of Health and Human Services, Public Health Service, RockvilleGoogle Scholar
  46. 46.
    Snyder DL, Doggartt D, Turkelson C (2004) Treatment of degenerative lumbar spinal stenosis. Am Fam Physician 70:517–520PubMedGoogle Scholar
  47. 47.
    Abdi S, Datta S, Trescottt A et al (2007) Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician 10:185–212PubMedGoogle Scholar
  48. 48.
    Stafford MA, Peng P, Hill DA (2010) Sciatica: a review of history, epidemiology, pathogenesis and the role of epidural steroid injection in management. BJA 99:461–473CrossRefGoogle Scholar
  49. 49.
    Handa N, Yamamoto H et al (1997) Exerc Ther Physiother 8(1):63–69Google Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  1. 1.Emergency DepartmentHôpital Lariboisière, APHPParisFrance
  2. 2.Geriatrics DepartmentHôpital Lariboisière, APHPParisFrance

Personalised recommendations