title: 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.
abstract: 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 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.
  
  
  CONCLUSIONS
  The algorithm presented gives a structured approach to guide primary care providers in planning treatment for patients with MP as a contributor to CLBP.
authors.affiliation: VA Connecticut Healthcare System.|Rehabilitation and Prosthetics Services, Veterans Health Administration.|University of Bridgeport College of Chiropractic.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Lisi
authors.affiliation: University of Pittsburgh Medical Center Centers for Rehab Services.
authors.forename: Paula
authors.initials: P
authors.lastname: Breuer
authors.affiliation: Departments of Psychiatry.|Department of Anesthesiology, University of Pennsylvania.|Pain Service, Philadelphia VA Medical Center.
authors.forename: Rollin M
authors.initials: RM
authors.lastname: Gallagher
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine.
authors.forename: Eric
authors.initials: E
authors.lastname: Rodriguez
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine.|Geriatric Research, Education & Clinical Center (GRECC), VA Pittsburgh Healthcare System.
authors.forename: Michelle I
authors.initials: MI
authors.lastname: Rossi
authors.affiliation: Durham VA Medical Center, GRECC.|Department of Medicine, Duke University Medical Center, Division of Geriatrics.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Schmader
authors.affiliation: Washington DC VA Medical Center.|Rehabilitation and Prosthetics Services, Veterans Health Administration.
authors.forename: Joel D
authors.initials: JD
authors.lastname: Scholten
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine.|Geriatric Research, Education & Clinical Center (GRECC), VA Pittsburgh Healthcare System.|Department of Psychiatry.|Anesthesiology.|Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D059350:Chronic Pain / Q000503:physiopathology / Q000628:therapy*; D019317:Evidence-Based Medicine; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000503:physiopathology / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D017410:Practice Guidelines as Topic; D012648:Self Care / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: Chronic Low Back Pain; Chronic Pain; Degenerative Disc Disease; Elderly; Low Back Pain; Lumbar; Myofascial Pain; Older Adults; Pain Disorder; Spinal Stenosis