(109) Aging Back Clinics – A Geriatric Syndrome Approach to Treating Low Back Pain in Older Adults: Results of a Preliminary Randomized Controlled Trial

Treating chronic low back pain (CLBP) with spine-focused interventions is common, potentially dangerous, and often ineffective. We posit that CLBP in older adults is a geriatric syndrome – a final common pathway for the expression of multiple contributors. We have published evidence and expert consensus-based algorithms to guide evaluation and treatment of key biopsychosocial CLBP contributors in older adults – hip osteoarthritis, myofascial pain, fibromyalgia, sacroiliac joint syndrome, lumbar spinal stenosis, leg length inequality, lateral hip/thigh pain, anxiety, depression, insomnia, and maladaptive coping. This preliminary trial tests the feasibility and efficacy of care based on these algorithms in Aging Back Clinics (ABC). Fifty-five English-speaking Veterans age 60-89 with CLBP and no red flags, prior back surgery, dementia, impaired communication, or uncontrolled psychiatric illness were randomized to ABC care or usual care (UC) over 6 months. ABC care was implemented by geriatricians trained in CLBP assessment who: 1) performed a structured history and physical examination to identify pain contributors, 2) provided structured education to participants about their contributors, and 3) recommended additional care using collaborative decision making. Primary outcomes were low back pain severity (0 to 10 current, and 7-day average and worst pain) and pain-related disability (Roland Morris [RM] questionnaire). Follow up data were collected monthly by telephone. ABC participants experienced significantly greater reduction in 7-day average (-1.22 points; p=0.023) and worst pain (-1.70 points; p=0.003) at 6 months. Neither present pain nor RM score at 6-months was statistically significant but favored ABC in magnitude. Descriptively, participants randomized to UC were more likely to experience pain-related emergency room visits (45.8 vs 30.8%; p=0.5136) and be exposed to Beers’ list medications, specifically non-COX2 nonsteroidal anti-inflammatory drugs (73.1% vs. 54.2) and muscle relaxants (42.3% vs. 16.7). These preliminary data suggest that ABC care reduces pain and exposure to other potential morbidity. Treating chronic low back pain (CLBP) with spine-focused interventions is common, potentially dangerous, and often ineffective. We posit that CLBP in older adults is a geriatric syndrome – a final common pathway for the expression of multiple contributors. We have published evidence and expert consensus-based algorithms to guide evaluation and treatment of key biopsychosocial CLBP contributors in older adults – hip osteoarthritis, myofascial pain, fibromyalgia, sacroiliac joint syndrome, lumbar spinal stenosis, leg length inequality, lateral hip/thigh pain, anxiety, depression, insomnia, and maladaptive coping. This preliminary trial tests the feasibility and efficacy of care based on these algorithms in Aging Back Clinics (ABC). Fifty-five English-speaking Veterans age 60-89 with CLBP and no red flags, prior back surgery, dementia, impaired communication, or uncontrolled psychiatric illness were randomized to ABC care or usual care (UC) over 6 months. ABC care was implemented by geriatricians trained in CLBP assessment who: 1) performed a structured history and physical examination to identify pain contributors, 2) provided structured education to participants about their contributors, and 3) recommended additional care using collaborative decision making. Primary outcomes were low back pain severity (0 to 10 current, and 7-day average and worst pain) and pain-related disability (Roland Morris [RM] questionnaire). Follow up data were collected monthly by telephone. ABC participants experienced significantly greater reduction in 7-day average (-1.22 points; p=0.023) and worst pain (-1.70 points; p=0.003) at 6 months. Neither present pain nor RM score at 6-months was statistically significant but favored ABC in magnitude. Descriptively, participants randomized to UC were more likely to experience pain-related emergency room visits (45.8 vs 30.8%; p=0.5136) and be exposed to Beers’ list medications, specifically non-COX2 nonsteroidal anti-inflammatory drugs (73.1% vs. 54.2) and muscle relaxants (42.3% vs. 16.7). These preliminary data suggest that ABC care reduces pain and exposure to other potential morbidity.