Background It has been suggested that older persons are less likely to receive optimal care for pain and a recent population study suggested that the management of low back pain in primary care differed with age (Macfarlane et al, 2012). In particular older patients were more likely than younger to receive pharmacological management, either with or without other treatments. However, the evidence base for managing low back pain patients with manual therapy or physical activity/exercise does not provide any support that their effectiveness differs by age (Schild von Spannenberg et al, 2012).
Objectives To determine from medical records whether, amongst persons with back pain visiting their general practitioner (GP), management differs with age.
Methods In a large-scale population-based survey in two areas of the UK, adults over 24 years were asked about current pain (and location), whether they consulted their GP, and management received. Among respondents, a sample was drawn of people registered at four practices who a) reported current back pain, b) had visited their GP for pain within the last year and c) gave permission to access records. Records were examined for consultations beginning a year before survey completion and, from any identified consultations, data was extracted on pain site and GP action. Management by age was analysed by logistic regression and odds ratios with 95% Confidence Intervals (CI) were calculated.
Results 240 patients were identified of whom 144 had a total of 456 recorded consultations for back pain. Tertiles of patient age were 25-50, 51-67 and 68-91 years. Medication was prescribed at 97 (64%) consultations in the youngest, 87 (57%) in the middle age-group (OR 0.76; 95% CI, 0.48-1.20), and 78 (51%) in the oldest (0.60; 0.38-0.95). Lifestyle advice, physical therapy or exercise were less likely to be prescribed in the oldest compared to the youngest group (17% v. 30%) OR 0.48 (0.28-0.82) while the oldest were more likely to be referred to a specialist or for investigation (28% v. 18%) OR 1.67 (0.98-2.86).
Conclusions Previous findings that suggested pharmacological management was more common at older ages were not supported. However older persons were less likely to be given lifestyle advice, physical therapy or prescribed exercise. Although these observations require replication, it is important to ensure that older persons consulting to general practice are benefitting from evidence-based non-pharmacological management of back pain.
References Macfarlane GJ, Beasley M, Jones EA, Prescott GJ, Docking R, Keeley P, McBeth J, Jones GT; MUSICIAN Study Team. The prevalence and management of low back pain across adulthood: results from a population-based cross-sectional study (the MUSICIAN study). Pain. 2012;153(1):27-32.
Schild von Spannenberg S, Jones GT, Macfarlane GJ. The evidence base for managing older persons with low back pain. British Journal of Pain 2012;6(4):166-9
Acknowledgements The following are members of the MUSICIAN study team: Gary Macfarlane (Principal Investigator), John McBeth (Investigator), Deborah Symmons (Investigator), Karina Lovell (investigator), Philip Keeley (Investigator), Phil Hannaford (Investigator), Chrysa Gkazinou (Trial manager), Marcus Beasley (Research Assistant), Elizabeth Jones (PhD student), Gordon Prescott (Statistician), and Steve Woby (Investigator).
Disclosure of Interest None Declared