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

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Deconstructing Chronic Low Back Pain in the Older Adult—Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part VII: Insomnia
Key Take-Away: 

The chronic low back pain (CLBP) is a common problem experienced by the older generation. Insomnia and CLBP often goes hand in hand with each other and poses a big problem which needs to be managed carefully. Hence, in this research, a proper treatment algorithm has been explored for treatment planning in CLBP and insomnia patients.

This article focuses on insomnia and presents a treatment algorithm for managing insomnia in older adults, along with a representative clinical case.

ABSTRACT: 
Background: 

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).

Conclusion: 

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.

Pain Med.2016 May;17(5):851-63

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