Public health

Older people missing from back pain trials

Older people have gone missing again – hidden amidst the general lack of evidence for effective treatments of spinal pain.

The 5th World Congress on Controversies, Debates & Consensus in Bone, Muscle & Joint Diseases was told that 42% of clinical trials excluded people over 65 years of age.

Associate Professor Manuela Ferreira, senior researcher at the Kolling Institute of Medical Research, said the problem was magnified by the impact of back pain in the elderly.

Back pain affected people’s capacity to care for themselves and their social participation. About one in ten people over 80 years were affected by severe disabling back pain yet their experience was not shared in the literature.

“It hasn’t changed over the years from 1990 to 2010. Over 20 years, older people have been consistently excluded from clinical trials.”

Associate Professor Ferreira said where there was evidence, it showed that older people were more likely to be prescribed painkillers and less likely to receive physical therapies for their pain.

She said data from the US showed that 36% of older adults were prescribed opioids.

Yet older people did respond to conservative treatments in a similar way to younger adults.

“It’s all about education. We need to be increasing awareness that older people will respond the same way [as younger adults]… Many times patients will come to the doctor wanting the strong painkiller,” she said.

She said her team were currently testing some technology-based approaches such as text messaging and a website as a support for self-management of back pain in older people.

Associate Professor Ferreira told the limbic that as well as including more older people in clinical trials, there should be more use of outcome measures that were relevant to them.

“Return to work might not be as important for older people, but falls is extremely important,” she said.

She said diagnosis was problematic given age-related degeneration of the spine.

“If you give patients a diagnosis based on imaging, they are more likely to become chronic because they get worried and they stop moving. They are also more likely to have surgery irrespective of need.”

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