Elizabeth A DiNapoli1, Michael Craine2, Paul Dougherty3, Angela Gentili4, Gary Kochersberger5, Natalia E Morone6, Jennifer L Murphy7, Juleen Rodakowski8, Eric Rodriguez9, Stephen Thielke10, Debra K Weiner11. 1. *Mental Illness Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA. 2. VA Eastern Colorado Healthcare System, Denver, Colorado Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, Colorado. 3. Canandaigua VA Medical Center, Canandaigua, New York New York Chiropractic College, Seneca Falls, New York. 4. Hunter Holmes McGuire VA Medical Center, Richmond, Virginia Virginia Commonwealth University Health System, Richmond, Virginia. 5. Canandaigua VA Medical Center, Canandaigua, New York Division of Geriatrics, University of Rochester, Rochester, New York. 6. Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 7. James A. Haley Veterans' Hospital, Tampa, Florida University of South Florida, Tampa, Florida. 8. Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania. 9. Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 10. Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington. 11. Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Geriatric Research, Education & Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA Clinical and Translational Sciences Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA debra.weiner@va.gov.
Abstract
OBJECTIVE: As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping--a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP. METHODS: A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors' clinical practice. RESULTS: We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management. CONCLUSIONS: To promote early engagement in skill-focused treatments, providers can routinely evaluate pain coping strategies in older adults with CLBP using a treatment algorithm. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.
OBJECTIVE: As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping--a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP. METHODS: A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors' clinical practice. RESULTS: We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management. CONCLUSIONS: To promote early engagement in skill-focused treatments, providers can routinely evaluate pain coping strategies in older adults with CLBP using a treatment algorithm. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.
Entities:
Keywords:
Aged; Assessment; Chronic Low Back Pain; Chronic Pain; Elderly; Low Back Pain; Maladaptive Coping; Primary Care
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