Open AccessDeconstructing chronic low back pain in the older adult—Step by step evidence and expert‐based recommendations for evaluation and treatment part III: Fibromyalgia syndrome
Author(s) -
Fatemi Gita,
Fang Meika A.,
Breuer Paula,
Cherniak Paul E.,
Gentili Angela,
Hanlon Joseph T.,
Karp Jordan F.,
Morone Natalia E.,
Rodriguez Eric,
Rossi Michelle I.,
Schmader Kenneth,
Weiner Debra K.
Publication year - 2015
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12863
Subject(s) - fibromyalgia , medicine , low back pain , physical therapy , delphi method , alternative medicine , chronic pain , physical medicine and rehabilitation , family medicine , artificial intelligence , pathology , computer science
Objective To present the third in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. The series presents CLBP as a syndrome, a final common pathway for the expression of multiple contributors rather than a disease localized exclusively to the lumbosacral spine. Each article addresses one of 12 important contributors to pain and disability in older adults with CLBP. This article focuses on fibromyalgia syndrome (FMS). Methods A modified Delphi approach was used to create the evaluation and treatment algorithm, the table discussing the rationale behind each of the algorithm components, and the stepped‐care drug recommendations. The team involved in the creation of these materials consisted of a principal investigator, a 5‐member content expert panel, and a 9‐member primary care panel. The evaluation and treatment recommendations were based on availability of medications and other resources within the Veterans Health Administration (VHA) facilities. However, non‐VHA panelists were also involved in the development of these materials, which can be applied to both VA and civilian settings. The illustrative clinical case was taken from the clinical practice of the principal investigator. Results Following expert consultations and a review of the literature, we developed an evaluation and treatment algorithm with supporting materials to aid in the care of older adults with CLBP who have concomitant FMS. A case is presented that demonstrates the complexity of pain evaluation and management in older patients with CLBP and concomitant FMS. Conclusions Recognition of FMS as a common contributor to CLBP in older adults and initiating treatment targeting both FMS and CLBP may lead to improved outcomes in pain and disability.