title: Deconstructing Chronic Low Back Pain in the Older Adult: Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part IV: Depression.
abstract: OBJECTIVE
  To present the fourth 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 depression.
  
  
  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 three-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 depression, an important contributor to CLBP. The case illustrates an example of a complex clinical presentation in which depression was an important contributor to symptoms and disability in an older adult with CLBP.
  
  
  CONCLUSIONS
  Depression is common and should be evaluated routinely in the older adult with CLBP so that appropriately targeted treatments can be planned and implemented.
authors.affiliation: Departments of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Carley
authors.affiliation: Departments of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.|Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.|Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jordan F
authors.initials: JF
authors.lastname: Karp
authors.affiliation: Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA.|Virginia Commonwealth University Health System, Richmond, VA, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Gentili
authors.affiliation: School of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Marcum
authors.affiliation: Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: M Carrington
authors.initials: MC
authors.lastname: Reid
authors.affiliation: Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Rodriguez
authors.affiliation: Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.|VA Pittsburgh Healthcare System, GRECC, Pittsburgh, PA, USA.|Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.|Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Michelle I
authors.initials: MI
authors.lastname: Rossi
authors.affiliation: VITAS Healthcare, Miami, FL, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shega
authors.affiliation: Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA.|Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Thielke
authors.affiliation: Departments of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.|Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.|Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.|Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.|Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
mesh_terms: D000369:Aged, 80 and over; D000465:Algorithms; D059350:Chronic Pain / Q000628:therapy*; D003863:Depression / Q000150:complications / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy*; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D010147:Pain Measurement
keywords: Aged; Assessment; Chronic Pain; Depression; Elderly; Low Back Pain; Primary Care