For older adults with chronic low back pain (CLBP), functional impairment is often a way of life, and ineffective treatment is at the core of this problem. In order to change this too-frequent outcome so that quality of life can be maintained, we need new ways of managing patients with CLBP.
A recent study, published in the journal Pain Medicine, looked at the impact of treating older patients in Aging Back Clinics (ABC) and compared those outcomes to those of patients who received usual care. The Aging Back Clinics approached CLBP in older adults as a geriatric syndrome rather than focusing exclusively on the spine.
The study randomized 55 veterans, aged 60 to 89 with a diagnosis of low back pain. Twenty-five of the patients received ABC care and 30 received usual care. Patients were followed for six months, with the objective of testing the feasibility of caring for older adults in ABCs compared to the usual spine-focused care.
The study assessed three primary outcomes:
- Current low back pain severity on a zero to ten scale,
- 7-day worst pain on a zero to ten scale, and
- Pain related disability using the Roland Morris Disability Index.
Secondarily, the SF-12 Health Survey and healthcare utilization were assessed.
By the end of the six-month study, reports of current pain did not differ significantly between the ABC and the usual care group.
However, average pain the week prior was significantly reduced in the ABC group compared to the usual care group, as was worst pain in the week prior. In addition, there was less interference with social activities and lower usage of skeletal muscle relaxants in the ABC group.
There was no statistical difference between the groups in the Roland Morris Disability Index and SF-12.
These results led the researchers to conclude that “ABC care for older veterans with CLBP is feasible and may reduce pain and exposure to other potential morbidity.”
This is good news, but what does this “ABC care” actually look like? According to the study, this approach includes:
- a structured history and physical examination to identify pain contributors,
- structured participant education,
- collaborative decision-making, and
- care guided by condition-specific algorithms.
The need for this approach arises from the fact that, particularly in the aging population, CLBP is a symptom of other health issues such as hip problems, fibromyalgia, and even depression or anxiety. Taking a whole-person approach rather than a spine-focused approach has the potential to prevent the unnecessary use and toxic side effects of medications and other treatments.
Pain of any kind, but particularly CLBP, can be a burden on the patient and costly to the healthcare system and even the economy. While this study was specific to veterans, it makes sense to consider low-cost and low-effort ways to incorporate this approach into the neurology practice. The use of the structured tools and condition-specific algorithms of the ABC seems to be a good start toward this goal.