title: 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.
abstract: 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.
  
  
  CONCLUSIONS
  Hip OA is common and should be evaluated routinely in the older adult with CLBP so that appropriately targeted treatment can be designed.
authors.affiliation: Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.|Department of Medicine, Division of Geriatric Medicine, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.|Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.|Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.|Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.|David Geffen School of Medicine University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Meika
authors.initials: M
authors.lastname: Fang
authors.affiliation: Virginia Commonwealth University Health System, Virginia, USA.|Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Gentili
authors.affiliation: Division of Geriatrics, University of Rochester, Rochester, New York, USA.|VA Medical Center, Canandaigua, New York, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Kochersberger
authors.affiliation: Department of Medicine, Division of Geriatric Medicine, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Marcum
authors.affiliation: Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.|Department of Medicine, Division of Geriatric Medicine, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
authors.forename: Michelle I
authors.initials: MI
authors.lastname: Rossi
authors.affiliation: U.S. Department of Veterans Affairs, Pharmacy Benefits Management Services.|Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.|Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Semla
authors.affiliation: VITAS Health Care, Miami, Florida, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shega
mesh_terms: D000369:Aged, 80 and over; D000465:Algorithms; D059350:Chronic Pain; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D008297:Male; D015207:Osteoarthritis, Hip / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*
keywords: Aged; Assessment; Chronic Low Back Pain; Chronic Pain; Elderly; Hip Osteoarthritis; Low Back Pain; Primary Care