Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part II: Myofascial Pain

Pain Med. 2015 Jul;16(7):1282-9. doi: 10.1111/pme.12821. Epub 2015 Jun 18.

Abstract

Objective: To present an algorithm of sequential treatment options for managing myofascial pain (MP) in older adults, along with a representative clinical case.

Methods: A modified Delphi process was used to synthesize evidence-based recommendations. A multidisciplinary expert panel developed the algorithm, which was subsequently refined through an iterative process of input from a primary care physician panel.

Results: We present an algorithm and supportive materials to help guide the care of older adults with MP, an important contributor to chronic low back pain (CLBP). Addressing any perpetuating factors should be the first step of managing MP. Patients should be educated on self-care approaches, home exercise, and the use of safe analgesics when indicated. Trigger point deactivation can be accomplished by manual therapy, injection therapy, dry needling, and/or acupuncture.

Conclusions: The algorithm presented gives a structured approach to guide primary care providers in planning treatment for patients with MP as a contributor to CLBP.

Keywords: Chronic Low Back Pain; Chronic Pain; Degenerative Disc Disease; Elderly; Low Back Pain; Lumbar; Myofascial Pain; Older Adults; Pain Disorder; Spinal Stenosis.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Acupuncture Therapy / methods
  • Aged
  • Aged, 80 and over
  • Algorithms*
  • Analgesics / administration & dosage
  • Analgesics / therapeutic use
  • Chronic Pain / physiopathology
  • Chronic Pain / therapy*
  • Evidence-Based Medicine
  • Exercise / physiology
  • Female
  • Humans
  • Low Back Pain / physiopathology
  • Low Back Pain / therapy*
  • Male
  • Middle Aged
  • Myofascial Pain Syndromes / physiopathology
  • Myofascial Pain Syndromes / therapy*
  • Pain Management / methods*
  • Pain Measurement / methods
  • Practice Guidelines as Topic*
  • Self Care / methods
  • Treatment Outcome

Substances

  • Analgesics