It is not uncommon for people in their forties and above to experience lower back pain. It is estimated that more than seventy percent (70%) of the geriatric population has prevalent back pains. However, lower back pain in elderly people is more complex and challenging than in younger patients. Why is this? It is because low back pain in the elderly has more possible causes and may have a higher incidence of becoming progressively worse (malignant) and or visceral (pertaining to the internal organs)…
When diagnosing the causes of lower back pain in elderly people, it is important to determine whether it is of acute, chronic, or predominant leg pain associated with back pain causes. Evaluation on four major areas of elder people begins with careful history and physical examination; characteristics of the pain, warning signs of cancer, nonspinal medical problems, and pyschosocial factors.
Characteristics of pain include location, onset (whether gradual or sudden and severe), and positional change. With positional change, visceral pain is most often constant irregardless of position, while mechanical pain worsens only with movement, and elderly people with leg symptoms due to spinal stenosis are more comfortable sitting than standing up.
Over seven percent (7%) of elderly patients who are above fifty years old have malignant cases which cause back pains. Seek medical attention immediately if there is prior history of cancer, there is constant pain, there is still back pain even with progressive treatment, there is pain at night that disturbs sleep, and there is drastic weight loss. These are possible signs of cancer and deserve immediate treatment.
Diabetes-related vascular diseases may superficially mimic spinal stenosis, while heart diseases and congestive heart failure increases the risk of NSAID-related toxicity which are factors affecting the non-spinal medical problems. Having the need to care for an ill or disabled spouse may also prevent an elderly to seek medical treatment, as this is a psychosocial concern arising from lower back pain in elderly people. All these are reasons why it is very important to thoroughly assess the physical and mental function of the elderly patient, and if need be- extend social services to them.
Treartment to elderly people with lower back pain is specifically directed to relief of symptoms and improvement of function for the patients. Since surgery is rarely appropriate, combining medicine and physical therapy is recommended for best results and has the least risk of toxicity to elderly people. Occupational and physical therapists have been found to be crucial in educating patients with their back pain. In physical therapy, patients learn exercises and get treatments that aid the patients’ mobility and builds strength. Occupational therapy helps elderly people work around their pain, and teaches them to try new ways in doing things. High velocity chiropractic manipulation however, is not recommended since it may increase the elderly patients’ spinal fracture risk. Lumbar support, such as having a walking cane, substantially helps relieve back symptoms and also osteoarthritis. While tricyclic anti-depressants have proved to improve the patients’ quality of sleep and reduce lower back pain in elderly people.