Low back pain in people aged 60 years and over

A 63 year old woman presents with a three day history of severe low back pain. She has a 20-year history of intermittent back trouble, but this episode is more severe than previous episodes and came on without provocation. She is physically active and usually swims most days but is unable to do so with the current pain. Previously, over-the counter ibuprofen provided some relief, but this time it has had little effect. She asks about investigations, possible causes, and pain management options.

People aged 60 years and over are more likely to experience incapacitating and persistent episodes of low back pain than younger people.12 In most cases, no specific cause can be identified, hence the label “non-specific” low back pain, and the person is managed symptomatically.3 Specific causes are less common but still important to consider.

Contrary to current clinical guidelines45 and despite drug side effects and interactions being more common in older people,6 a population based cross sectional study in two UK regions found that a person in their 70s is less likely to be offered non-drug therapies such as exercise programmes and more likely to be offered pain medicines than someone in their 30s.7 Recent increased focus on the need for clinicians to better manage low back pain “without recourse to the prescription pad”8910 prompted us to describe how this might work in general practice for people ≥60 years.