Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part X: Sacroiliac Joint Syndrome.
To present an algorithm of sequential treatment options for managing sacroiliac joint (SIJ) pain in the setting of chronic low back pain (CLBP) in the older adult. This is the tenth part in a series, and includes an illustrative clinical case.



The stepped care drug table and evaluation and treatment algorithm were created following a thorough literature review of approaches and subsequent analysis through a modified Delphi process. The principal investigator developed the initial draft, which was refined for content by an interdisciplinary panel of five experts. The refined materials were then assessed for the feasibility of implementation and validity of recommendations for older adults in a primary care setting by a panel of nine primary care providers. While not exclusive to Veteran's Health Administration (VHA) facilities, an emphasis was made to include resources and medications available to providers in the VHA.



The algorithm and drug table developed to systematically identify and address SIJ pain in the older adult is presented here. The process should begin with recognizing the presenting symptoms of CLBP stemming from the SI region, and supporting physical exam testing using the compression test and thigh thrust maneuver. Identification of the SIJ as a pain generator is followed by assessment and treatment of contributory factors. SIJ pain treatment should begin with education and self-management including exercise, and may escalate to include interventional procedures and/or referral to a pain rehabilitation program.



Pain originating from the SIJ is often under-recognized, but a structured and consistent approach can help identify older patients who would benefit from treatment of this contributor to CLBP.



Chronic Low Back Pain; Sacroiliac Joint Pain; Older Adults.
*University of Pittsburgh School of Medicine, Pittsburgh, PA debra.weiner@va.gov.
Patrick J
PJ
Polsunas
Departments of Physical Medicine and Rehabilitation Orthopaedic Surgery Bioengineering-University of Pittsburgh, Pittsburgh, PA.
Gwendolyn
G
Sowa
Department of Physical Therapy, College of Health, University of Utah, Salt Lake City.
Julie M
JM
Fritz
Hunter Holmes McGuire VA Medical Center, Richmond, VA Virginia Commonwealth University Health System, Richmond, VA.
Angela
A
Gentili
**Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Natalia E
NE
Morone
Department of Anesthesiology Critical Care Medicine Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.
Srinivasa Naga
SN
Raja
Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Eric
E
Rodriguez
***Durham VA Medical Center, GRECC, Durham, NC Duke University Medical Center, Division of Geriatrics, Department of Medicine, Durham, NC.
Kenneth
K
Schmader
Washington DC VA Medical Center, Washington, DC Rehabilitation and Prosthetics Services, Veterans Health Administration, Washington, DC.
Joel D
JD
Scholten
**Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA Department of Psychiatry Department of Departments of Medicine, Division of Geriatric Medicine.
Debra K
DK
Weiner
D000368:Aged; D000465:Algorithms; D059350:Chronic Pain; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D012446:Sacroiliac Joint