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
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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CONCLUSIONS: Hip OA is common and should be evaluated routinely in the older adult with chronic low back pain (CLBP) so that appropriately targeted treatment can be designed.
KEYWORDS: Aged; Assessment; Chronic Low Back Pain; Chronic Pain; Elderly; Hip Osteoarthritis; Low Back Pain; Primary Care
From the FULL TEXT Article:
An estimated one in two people with hip osteoarthritis (OA) has low back pain (LBP).  The Hip-Spine Syndrome (HSS) was first described by Offierski in 1983.  Three types of patients were described – those with “simple” HSS who had pathology of both the hip and lumbar spine, but disability related to only one source; those with “complex” HSS who had symptoms from both the hip and spine without a clear single source of disability, such as patients with low back and leg pain and who have clinical evidence of both lumbar spinal stenosis and hip OA ; and those with “secondary” HSS who have inter-related pathology such as restricted hip motion from advanced OA causing abnormal biomechanics of the lumbo-pelvic-hip complex and consequent LBP.  Secondary HSS has been substantiated through studies demonstrating significant reduction or complete resolution of LBP in patients with hip OA following total hip arthroplasty (THA). [5-7]