Deconstructing Chronic Low Back Pain in the Older Adult – Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment.
Part V: Maladaptive Coping
SOURCE: Pain Medicine 2016 (Jan); 17 (1): 64-73 ~ FULL TEXT
Elizabeth A. DiNapoli, Michael Craine, Paul Dougherty,
Angela Gentili, Gary Kochersberger, Natalia E. Morone,
Jennifer L. Murphy, Juleen Rodakowski, Eric Rodriguez,
Stephen Thielke, Debra K. Weiner
Mental Illness Research, Education & Clinical Center,
VA Pittsburgh Healthcare System, Pittsburgh,
Pennsylvania Geriatric Research,
Education & Clinical Center,
VA Pittsburgh Healthcare System, Pittsburgh, PA
OBJECTIVE: As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping – a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP.
METHODS: A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors’ clinical practice.
RESULTS: We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management.
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