Treatment of Lower Back Pain in Geriatric Patients: A Multi-Tiered, Patient-Centered, Collaborative Treatment Approach
By Steven J. Anglés
March 12, 2015
Low back pain is a pervasive problem for many people that are often at a cross-roads on where to seek care following an injury. A unique 2013 study analyzed the perspectives of geriatric patients (aged 65 and older) coping with lower back pain who were treating with either medical doctors or chiropractors in a primary care capacity. The study also sought to explore the benefits and general preferences among patients towards a multidisciplinary approach for treatment of lower back pain. The study concluded that most geriatric patients preferred a co-managed and collaborative approach to treatment between their primary care physicians and chiropractors for their low back pain. Yet, co-occurring chiropractic and medical care is uncommon among geriatric patients, ranging from only 5% to 33% of all treatment of traumatic lower back pain.
Medical researchers from several universities collaborated with chiropractic researchers from the Palmer College of Chiropractic for this unique 2013 study. 10 focus groups, comprised of 48 geriatric patients who had received treatment for traumatic lower back injuries in the previous year, participated in the study between May, 2010 and November, 2011. Many of these patients had suffered traumatic injuries from motor vehicle collisions, falls, or other injury-producing events, while a portion of patients were suffering from lower back pain as a result of the degenerative aging process. While these patients opted for primary care with family or internal medicine physicians and doctors of chiropractic, they had also received care from physical therapists, neurologists, orthopedists, and massage therapists. Most participants had avoided injections or surgery as a means of treatment.
Participants across these groups considered chiropractic a primary, not complementary, resource for lower back pain treatment, preferring “hands-on” and unrushed consultations. They also acknowledged the desire to have general primary care needs addressed by a family physician independently from the primary chiropractic provider.
Participants in the study valued patient-centered communication above all else, and desired an openness to discussing chronic pain and diagnoses regardless of age as key components for collaborative care of lower back pain. The majority of the participants expressed a strong desire for consistent and clear communication between providers and towards patients, and a sharing of findings. Factors such as financial costs, scheduling, transportation issues, and side effects from medication or chiropractic treatments were identified as potential barriers to low back pain co-management among patients.
Both medical and chiropractic researchers concluded that while a co-managed approach to health care would be beneficial to patients of all ages, older patients would particularly benefit from such an approach due to high rates of chronic disease, polypharmacy, multi-morbidity, and rates of disability.
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 Lyons KJ, Salsbury SA, Hondras MA, Jones ME, Andresen AA, Goertz CM. Perspectives of older adults on co-management of low back pain by doctors of chiropractic and family medicine physicians: a focus group study, 2013. BMC Complementary and Alternative Medicine. 2013; 13: 225.
 Hawk C, Long CR, Boulanger KT, Morschhauser E, Fuhr AW. Chiropractic care for patients aged 55 years and older: report from a practice-based research program. J. Am Geriatr Soc. 2000 the; 48:534-545.