Globally, lower back pain is the third most common cause of years lived with disability in people aged 70 and over, behind diabetes and hearing loss.
In higher-income countries it’s the leading cause.
In people aged 60 and over, its prevalence ranges from 21%-75%, numbers increasing in those aged up to 80.
And with increasing age comes increased risk of pain lasting three months or more.
When you’re older, back pain can spark fear of frailty, cause social isolation and affect people’s independence, according to Dr Adrian C Traeger of Sydney University and colleagues.
Immobility from back pain can also rapidly lead to physical deconditioning with its inherent dangers. Depression and poor sleep are also more common in older adults with lower back pain compared to those with none.
There are many causes of this pain. Bone-related conditions are probably most prevalent due to pressure on a nerve root by a slipped disc or osteoarthritis of vertebral joints.
Then there’s narrowing of the spinal canal, malignancy and vertebral fracture all of which get more common with age.
Lower back pain with no specific cause accounts for 600-900 of 1,000 older adult sufferers, and treatments are numerous.
Exercise programmes are the mainstay of remaining active, tailor-made to suit individual people. Yoga, Tai Chi, Pilates, walking, running and swimming can all contribute to maintaining mobility and stability.
Acupuncture could be suitable for patients who’ve benefited previously though there’s little reliable evidence suggesting sustained benefits.
Spinal manipulation by a trained practitioner (such as a physiotherapist or chiropractor) may have small benefits, although these are deemed unlikely to be clinically necessary.
As far as drug treatments go, the National Institute for Health and Care Excellence and the American College of Physicians recommend NSAIDs for acute and chronic lower back pain, even though in trials they’re no better than a placebo.
If found to be effective, NSAIDs are prescribed at the lowest effective dose for the shortest possible time.
Paracetamol is unlikely to work but for older people there may be no safer alternatives.
Antidepressants can cause dizziness and sedation that may increase the risk of falling. Anticonvulsants are ineffective for back pain with or without sciatica, and gabapentinoids can be dangerous if combined with opioids and can increase risk of death.
Given the risk of respiratory depression, falls and fractures, opioids should be prescribed as a last resort and at the lowest effective dose for the shortest period.