Management of back pain in older patients

Abstract

The prevalence of pain in older patients and the consequences of undertreated pain pose a substantial burden to the patients, their family, and society. Low back pain (LBP) is a very common reason for visiting an emergency department (ED). The diagnosis of LBP in older patients in the ED should be based on careful history taking and physical findings. LBP is a consequence of age-related changes in the structure of the lumbar spine. They can be associated with the patient’s lifestyle. Osteoarthritis is the first cause of LBP in older patients, before inflammatory rheumatism. Diagnosis pitfalls among older patients are frequent and should always be evoked in the ED. Any acute behavior change in older patients must arise the suspicion of acute pain and therefore also LBP. Acetaminophen should be considered as first-line treatment for the management of LBP because of a demonstrated efficacy and a good safety profile. Opioids are now more widely accepted for treating older adults with persistent pain. Non-pharmacologic and essential pain management treatments exist including physical exercise.