title: Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part VII: Insomnia.
abstract: OBJECTIVE : To present the seventh in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on insomnia and presents a treatment algorithm for managing insomnia in older adults, along with a representative clinical case. METHODS : A modified Delphi process was used to develop the algorithm and supportive materials. A multidisciplinary expert panel representing expertise in health psychology and sleep medicine developed the algorithm and supporting documents that were subsequently refined through an iterative process of input from a primary care provider panel. RESULTS : We present an illustrative clinical case and an algorithm to help guide the care of older adults with insomnia, an important contributor to CLBP and disability. Multicomponent cognitive behavioral therapy for insomnia (CBTI) and similar treatments (e.g., brief behavioral treatment for insomnia [BBTI]) are the recommended first-line treatment. Medications should be considered only if BBTI/CBTI is suboptimal or not effective and should be prescribed at the lowest effective dose for short periods of time (< 90 days). CONCLUSIONS : Insomnia is commonly comorbid with CLBP in older adults and should be routinely evaluated and treated because it is an important contributor to pain and disability. The algorithm presented was structured to assist primary care providers in planning treatment for older adults with CLBP and insomnia.
authors.affiliation: *Mental Illness Research, Education & Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Bramoweth
authors.affiliation: *Mental Illness Research, Education & Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Jenna G
authors.initials: JG
authors.lastname: Renqvist
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Anne
authors.initials: A
authors.lastname: Germain
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
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: 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: **Department of Medicine, Division of Geriatric 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 (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania **Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Michelle I
authors.initials: MI
authors.lastname: Rossi
authors.affiliation: Geriatric Research, Education and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania **Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Clinical and Translational Science Institute-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: D000368:Aged; D000465:Algorithms; D059350:Chronic Pain / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003697:Delphi Technique; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014196:Trazodone / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D014196:Trazodone
keywords: Chronic Low Back Pain; Chronic Pain; Elderly; Insomnia; Low Back Pain; Older Adults; Sleep Disorders