February 13, 2020
Study findings published online in Pain Medicine, suggest that use Aging Back Clinics (ABC) for older adults with chronic low back pain (CLBP) is not only feasible, but it also may reduce both pain and exposure to other potential morbidity.
“Treating CLBP with spine-focused interventions is common, potentially dangerous, and often ineffective,” the authors of the study said. “This preliminary trial tests the feasibility and efficacy of caring for CLBP in older adults as a geriatric syndrome in ABC.”
The researchers observed 55 veterans, aged 60-89, with CLBP. In addition, the study participants did not present any red flags for serious underlying illness, prior back surgery, dementia, impaired communication, or uncontrolled psychiatric illness.
For the study, participants were randomized to ABC care or usual care and then followed for six months. ABC care included:
- a structured history and physical examination to identify pain contributors;
- structured participant education;
- collaborative decision-making; and
- care guided by condition-specific algorithms.
“Primary outcomes were low back pain severity (0–10 current and seven-day average/worst pain) and pain-related disability (Roland Morris). Secondary outcomes included the SF-12 and health care utilization.”
According to the findings, participants treated in the clinics experienced greater reduction in seven-day average (–1.22 points, P = 0.023) and worst pain (–1.70 points, P = 0.003) and SF-12 interference with social activities (50.0 vs 11.5%, P = 0.0030) at six months. Further, participants treated in the clinics were less likely to take muscle relaxants (16.7 vs 42.3%, P = 0.0481).
The study authors found that the participants treated in usual care were at an increased risk to experience pain-related emergency room visits (45.8% vs 30.8%) and to be exposed to non-COX2 nonsteroidal anti-inflammatory drugs (73.1% vs 54.2%).
“These preliminary data suggest that ABC care for older veterans with CLBP is feasible and may reduce pain and exposure to other potential morbidity,” study authors concluded.
Weiner DK, Gentili A, Rossi M, et al. Aging Back Clinics—a Geriatric Syndrome Approach to Treating Chronic Low Back Pain in Older Adults: Results of a Preliminary Randomized Controlled Trial [published online ahead of print September 10, 2019]. Pain Med. 2020;21:(2):274-290. doi: https://doi.org/10.1093/pm/pnz179