Deconstructing chronic low back pain in the older adult--Step by step evidence and expert-based recommendations for evaluation and treatment part III: Fibromyalgia syndrome.
OBJECTIVE
To present the third 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 12 important contributors to pain and disability in older adults with CLBP. This article focuses on fibromyalgia syndrome (FMS).


METHODS
A modified Delphi approach was used to create the evaluation and treatment algorithm, the table discussing the rationale behind each of the algorithm components, and the stepped-care drug recommendations. The team involved in the creation of these materials consisted of a principal investigator, a 5-member content expert panel, and a 9-member primary care panel. The evaluation and treatment recommendations were based on availability of medications and other resources within the Veterans Health Administration (VHA) facilities. However, non-VHA panelists were also involved in the development of these materials, which can be applied to both VA and civilian settings. The illustrative clinical case was taken from the clinical practice of the principal investigator.


RESULTS
Following expert consultations and a review of the literature, we developed an evaluation and treatment algorithm with supporting materials to aid in the care of older adults with CLBP who have concomitant FMS. A case is presented that demonstrates the complexity of pain evaluation and management in older patients with CLBP and concomitant FMS.


CONCLUSIONS
Recognition of FMS as a common contributor to CLBP in older adults and initiating treatment targeting both FMS and CLBP may lead to improved outcomes in pain and disability.
VA Greater Los Angeles Healthcare System, Los Angeles, California.|David Geffen School of Medicine University of California Los Angeles, Los Angeles, California.
Gita
G
Fatemi
VA Greater Los Angeles Healthcare System, Los Angeles, California.|David Geffen School of Medicine University of California Los Angeles, Los Angeles, California.
Meika A
MA
Fang
University of Pittsburgh Medical Center, Centers for Rehab Services, Pittsburgh, Pennsylvania.
Paula
P
Breuer
Division of Geriatrics and Palliative Medicine, University of Miami Miller School of Medicine, Miami, Florida.|Bruce W. Carter Miami VA Medical Center, Miami, Florida.
Paul E
PE
Cherniak
Virginia Commonwealth University Health System, Richmond, Virginia.|Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.
Angela
A
Gentili
Departments of Geriatric Medicine.|Pharmacy and Therapeutics, School of Pharmacy.|Epidemiology, School of Public Health, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.|Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Center for Health Equity Research and Promotion at the VA Pittsburgh Health System, Pittsburgh, Pennsylvania.
Joseph T
JT
Hanlon
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.|Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
Jordan F
JF
Karp
Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.|Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Natalia E
NE
Morone
Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Eric
E
Rodriguez
Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Michelle I
MI
Rossi
GRECC, Durham VA Medical Center, Durham, North Carolina.|Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, North Carolina.
Kenneth
K
Schmader
Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.|Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.|Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Debra K
DK
Weiner
D000368:Aged; D000465:Algorithms; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005356:Fibromyalgia / Q000150:complications*; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement
Back Pain; Chronic Pain; Elderly; Fibromyalgia; Low Back Pain