OBJECTIVE: Treating chronic low back pain (CLBP) with spine-focused interventions is common, potentially dangerous, and often ineffective. This preliminary trial tests the feasibility and efficacy of caring for CLBP in older adults as a geriatric syndrome in Aging Back Clinics (ABC).
DESIGN: Randomized controlled trial.
SETTING: Outpatient clinics of two VA Medical Centers.
SUBJECTS: Fifty-five English-speaking veterans aged 60-89 with CLBP and no red flags for serious underlying illness, prior back surgery, dementia, impaired communication, or uncontrolled psychiatric illness.
METHODS: Participants were randomized to ABC care or usual care (UC) and followed for six months. ABC care included 1) a structured history and physical examination to identify pain contributors, 2) structured participant education, 3) collaborative decision-making, and 4) 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.
RESULTS: ABC participants experienced significantly 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. ABC participants were less likely to take muscle relaxants (16.7 vs 42.3%, P = 0.0481). Descriptively, UC participants were more likely 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%).
CONCLUSIONS: These preliminary data suggest that ABC care for older veterans with CLBP is feasible and may reduce pain and exposure to other potential morbidity.
Comprehensive care is better than unfocused care? Likely this is typical for many types of chronic pain, and has little to do with 'geriatric syndrome care'.
ABC procedure appears too complicated for average practitioners.
It's amazing that out of 1498 patients the authors got down to 572 and of those 471 did not respond to letters. Did that group really have chronic back pain? One would suspect not if they failed to respond. Then splitting the finalists into 2 groups of about 25 each for a comparative study over the period listed would seem to be a statistically flawed study, even for a pilot. Further, what did the authors mean by indicating that the MRI's were negative? In this age group, a negative MRI of the back in someone with chronic LBP would be like finding a hen's tooth.