Managing Back Pain In Older Adults
Back pain in older adults is very common, and a practice pointer study in the BMJ was published by some well known researchers, such as Adrian Traegar and Rachelle Buchbinder, who highlight some of the current information in this area. Much of the information is new or changing, largely due to the increased healthcare focus on The Baby Boomer Generation.
Back pain is common in the general population, and at one point it was thought that back pain tended to decrease as we became older. However, Traegar et al point out that it actually increases in prevalence with age, and potentially it is associated with more serious pathologies. Why?
Well, in the younger population, low back pain is often considered benign; rarely is it associated with serious disease. But in an older population, other causes of back pain sucha as cauda equina syndrome, infection, aortic aneurism, fracture or cancer are slightly higher. And there are also diseases of the spine that occur only in older populations, particularly canal stenosis. Yet still, non-specific low back pain remains most common. Ie, it is often a benign condition. It requires a thorough history and exam to differentiate the causes.
There are also some tests to consider in this population.
Traeger et al note that the evidence base is very limited at the moment. At the time of the writing, there were only 11 trials.
Spinal manipulation is considered one treatment option for this population. Heat packs, also, have some evidence. Since the BMJ article, a systematic review has been published in The European Journal of Spine. This study found favourable evidence for the treatment of an older population using spinal manipulation, which guidelines also recommend in the general population.
Of course, we would take our time with this population, perform an accurate diagnosis, and modify the treatment accordingly. But, overall, there is a safe and effective approach that can help older adults with low back pain that is recommended by guidelines, researchers and interdisciplinary musculoskeletal experts.
Jenks A, de Zoete A, van Tulder M, Rubinstein SM; International IPD-SMT group. Spinal manipulative therapy in older adults with chronic low back pain: an individual participant data meta-analysis. Eur Spine J. 2022 Jul;31(7):1821-1845. doi: 10.1007/s00586-022-07210-1. Epub 2022 May 28. PMID: 35633383.
Traeger AC, Underwood M, Ivers R, Buchbinder R. Low back pain in people aged 60 years and over. BMJ. 2022 Mar 22;376:e066928. doi: 10.1136/bmj-2021-066928. PMID: 35318211.