title: Deconstructing Chronic Low Back Pain in the Older Adult--Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part V: Maladaptive Coping.
abstract: OBJECTIVE
  As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping--a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP.
  
  
  METHODS
  A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors' clinical practice.
  
  
  RESULTS
  We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management.
  
  
  CONCLUSIONS
  To promote early engagement in skill-focused treatments, providers can routinely evaluate pain coping strategies in older adults with CLBP using a treatment algorithm.
authors.affiliation: *Mental Illness Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: DiNapoli
authors.affiliation: VA Eastern Colorado Healthcare System, Denver, Colorado Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, Colorado.
authors.forename: Michael
authors.initials: M
authors.lastname: Craine
authors.affiliation: Canandaigua VA Medical Center, Canandaigua, New York New York Chiropractic College, Seneca Falls, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Dougherty
authors.affiliation: Hunter Holmes McGuire VA Medical Center, Richmond, Virginia Virginia Commonwealth University Health System, Richmond, Virginia.
authors.forename: Angela
authors.initials: A
authors.lastname: Gentili
authors.affiliation: Canandaigua VA Medical Center, Canandaigua, New York Division of Geriatrics, University of Rochester, Rochester, New York.
authors.forename: Gary
authors.initials: G
authors.lastname: Kochersberger
authors.affiliation: Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Natalia E
authors.initials: NE
authors.lastname: Morone
authors.affiliation: James A. Haley Veterans' Hospital, Tampa, Florida University of South Florida, Tampa, Florida.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Murphy
authors.affiliation: Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Juleen
authors.initials: J
authors.lastname: Rodakowski
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Eric
authors.initials: E
authors.lastname: Rodriguez
authors.affiliation: Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
authors.forename: Stephen
authors.initials: S
authors.lastname: Thielke
authors.affiliation: Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA debra.weiner@va.gov.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
mesh_terms: D000223:Adaptation, Psychological / Q000187:drug effects* / Q000502:physiology; D000368:Aged; D059350:Chronic Pain / Q000628:therapy*; D003697:Delphi Technique; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D010147:Pain Measurement; D016896:Treatment Outcome
keywords: Aged; Assessment; Chronic Low Back Pain; Chronic Pain; Elderly; Low Back Pain; Maladaptive Coping; Primary Care