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Monthly Archives: January 2016

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Deconstructing Chronic Low Back Pain in the Older Adult –
Part IV: Depression

By |January 31, 2016|Depression Screening, Low Back Pain|

Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment.
Part IV: Depression

The Chiro.Org Blog


SOURCE: Pain Medicine 2015 (Nov); 16 (11): 2098-2108 ~ FULL TEXT

Joseph A. Carley, Jordan F. Karp, Angela Gentili,
Zachary A. Marcum, M. Carrington Reid, Eric Rodriguez,
Michelle I. Rossi, Joseph Shega, Stephen Thielke,
Debra K. Weiner

Departments of Psychiatry,
University of Pittsburgh,
Pittsburgh, PA, USA


OBJECTIVE:   To present the fourth in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on depression.

METHODS:   The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a three-member content expert panel, and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor’s clinical practice.

RESULTS:   We present an algorithm and supportive materials to help guide the care of older adults with depression, an important contributor to CLBP. The case illustrates an example of a complex clinical presentation in which depression was an important contributor to symptoms and disability in an older adult with CLBP.

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Deconstructing Chronic Low Back Pain in the Older Adult –
Part III: Fibromyalgia Syndrome

By |January 30, 2016|Low Back Pain|

Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part III: Fibromyalgia Syndrome

The Chiro.Org Blog


SOURCE:   Pain Medicine 2015 (Sep); 16 (9): 1709-1719 ~ FULL TEXT

Gita Fatemi, Meika A. Fang, Paula Breuer, Paul E. Cherniak,
Angela Gentili, Joseph T. Hanlon, Jordan F. Karp,
Natalia E. Morone, Eric Rodriguez, Michelle I. Rossi,
Kenneth Schmader, Debra K. Weiner

VA Greater Los Angeles Healthcare System,
Los Angeles, California


OBJECTIVE:   To present the third in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of 12 important contributors to pain and disability in older adults with CLBP. This article focuses on fibromyalgia syndrome (FMS).

METHODS:   A modified Delphi approach was used to create the evaluation and treatment algorithm, the table discussing the rationale behind each of the algorithm components, and the stepped-care drug recommendations. The team involved in the creation of these materials consisted of a principal investigator, a 5-member content expert panel, and a 9-member primary care panel. The evaluation and treatment recommendations were based on availability of medications and other resources within the Veterans Health Administration (VHA) facilities. However, non-VHA panelists were also involved in the development of these materials, which can be applied to both VA and civilian settings. The illustrative clinical case was taken from the clinical practice of the principal investigator.

RESULTS:   Following expert consultations and a review of the literature, we developed an evaluation and treatment algorithm with supporting materials to aid in the care of older adults with CLBP who have concomitant FMS. A case is presented that demonstrates the complexity of pain evaluation and management in older patients with CLBP and concomitant FMS.

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Deconstructing Chronic Low Back Pain in the Older Adult –
Part II: Myofascial

By |January 27, 2016|Low Back Pain|

Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment.
Part II: Myofascial Pain

The Chiro.Org Blog


SOURCE:   Pain Medicine 2015 (Jul); 16 (7): 1282-1289 ~ FULL TEXT

Anthony J. Lisi, Paula Breuer, Rollin M. Gallagher,
Eric Rodriguez, Michelle I. Rossi, Kenneth Schmader,
Joel D. Scholten, Debra K. Weiner

VA Connecticut Healthcare System
2Rehabilitation and Prosthetics Services,
Veterans Health Administration.
3University of Bridgeport College of Chiropractic


OBJECTIVE:   To present an algorithm of sequential treatment options for managing myofascial pain (MP) in older adults, along with a representative clinical case.

METHODS:   A modified Delphi process was used to synthesize evidence-based recommendations. A multidisciplinary expert panel developed the algorithm, which was subsequently refined through an iterative process of input from a primary care physician panel.

RESULTS:   We present an algorithm and supportive materials to help guide the care of older adults with MP, an important contributor to chronic low back pain (CLBP). Addressing any perpetuating factors should be the first step of managing myofascial pain (MP). Patients should be educated on self-care approaches, home exercise, and the use of safe analgesics when indicated. Trigger point deactivation can be accomplished by manual therapy, injection therapy, dry needling, and/or acupuncture.

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Deconstructing Chronic Low Back Pain in the Older Adult –
Part I: Hip Osteoarthritis

By |January 26, 2016|Low Back Pain|

Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment.
Part I: Hip Osteoarthritis

The Chiro.Org Blog


SOURCE:   Pain Medicine 2015 (May); 16 (5): 886-897 ~ FULL TEXT

Debra K. Weiner, Meika Fang, Angela Gentili,
Dr. Gary Kochersberger, Zachary A. Marcum,
Michelle I. Rossi, Todd P. Semla, Joseph Shega

Geriatric Research, Education and Clinical Center,
VA Pittsburgh Healthcare System,
Pittsburgh, Pennsylvania, USA.


OBJECTIVE:   To present the first in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of twelve important contributors to pain and disability in older adults with CLBP. This article focuses on hip osteoarthritis (OA).

METHODS:   The evaluation and treatment algorithm, a table articulating the rationale for the individual algorithm components, and stepped-care drug recommendations were developed using a modified Delphi approach. The Principal Investigator, a five-member content expert panel and a nine-member primary care panel were involved in the iterative development of these materials. The algorithm was developed keeping in mind medications and other resources available within Veterans Health Administration (VHA) facilities. As panelists were not exclusive to the VHA, the materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor’s clinical practice.

RESULTS:   We present an algorithm and supportive materials to help guide the care of older adults with hip OA, an important contributor to CLBP. The case illustrates an example of complex hip-spine syndrome, in which hip OA was an important contributor to disability in an older adult with CLBP.

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Deconstructing Chronic Low Back Pain in the Older Adult –
Introduction

By |January 23, 2016|Low Back Pain|

Deconstructing Chronic Low Back Pain in the Older Adult – Shifting the Paradigm from the Spine to the Person – Introduction

The Chiro.Org Blog


SOURCE:   Pain Medicine 2015 (May); 16 (5): 881-885 ~ FULL TEXT

Debra K. Weiner

Geriatric Research, Education & Clinical Center,
VA Pittsburgh Healthcare System,
University of Pittsburgh,
Pittsburgh, PA, USA.


Over the past decade, the estimated prevalence of low back pain (LBP) among older adults (typically defined as those ≥age 65) has more than doubled [1], and the utilization of advanced spinal imaging (e.g., computerized tomography (CT), magnetic resonance imaging [MRI]) and procedures guided by this imaging (e.g., epidural corticosteroids, spinal surgery) have continued to skyrocket. [1-3]

Treatment outcomes, however, have not improved apace. Why? Part of the answer lies in the fact that treatment may in part be misdirected.

This issue of Pain Medicine contains the first in a series of articles on how to systematically and comprehensively rethink our approach to evaluating and designing management for older adults with chronic low back pain (CLBP). The series is entitled “Deconstructing Chronic Low Back Pain in the Older Adult: Step-by-Step Evidence and Expert-Based Recommendations for Evaluation and Treatment” and the article in this issue focuses on hip osteoarthritis (OA), an important potential contributor to CLBP in older adults.

KEYWORDS:   Back Pain; Chronic Low Back Pain; Chronic Pain; Elderly; Geriatric; Homeostenosis; Low Back Pain; Lumbar; Magnetic Resonance Imaging; Older Adults; Pain Management; Treatment Outcome


From the FULL TEXT Article:

Current Practice

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