title: Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part IX: Anxiety.
abstract: As a part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on anxiety-a significant contributor of reduced health-related quality of life, increased use of medical services, and heightened disability in older adults with CLBP.
  
  
  
  A modified Delphi technique was used to develop an algorithm for the screening and clinical care of older adults with CLBP and anxiety. A 4-member content expert panel and a nine-member primary care panel were involved in this iterative development process. Evidence underlying the recommendations is not strictly based on VA populations; therefore, the algorithm can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor's clinical practice.
  
  
  
  We present a treatment algorithm and supporting tables to be used by providers treating older adults who have anxiety and CLBP. A case of an older adult with anxiety and CLBP is provided to illustrate the approach to management.
  
  
  
  To promote early engagement in evidence-based treatments, providers should routinely evaluate anxiety in older adults with CLBP using a screening and treatment algorithm.
authors.affiliation: *Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Department of Psychiatry Department of Anesthesiology Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Jordan F
authors.initials: JF
authors.lastname: Karp
authors.affiliation: Department of Psychiatry Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: DiNapoli
authors.affiliation: VA San Diego Healthcare System, San Diego, California University of California, San Diego, San Diego, California.
authors.forename: Julie
authors.initials: J
authors.lastname: Wetherell
authors.affiliation: Department of Psychiatry.
authors.forename: Chloe
authors.initials: C
authors.lastname: Bolon
authors.affiliation: **Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Eric
authors.initials: E
authors.lastname: Rodriguez
authors.affiliation: VITAS Healthcare, Miami, Florida, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shega
authors.affiliation: *Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Department of Psychiatry Department of Anesthesiology Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania **Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA Debra.Weiner@va.gov.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Weiner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001007:Anxiety / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D059350:Chronic Pain / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003697:Delphi Technique; D003936:Diagnosis, Computer-Assisted; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged
keywords: Anxiety; Avoidance Behavior; Chronic Pain; Cognitive Behavior Therapy; Fear; Low Back Pain