Not So Golden After All

The Complexities of Chronic Low Back Pain in Older Adulthood

Meredith L. Stensland, PhD, LMSW; Sara Sanders, PhD, MSW


Gerontologist. 2018;58(5):923-931. 

In This Article

Background and Objectives

The population of older adults is increasing both nationally and globally (Administration on Aging, 2014; He, Goodkind, & Kowal, 2016). In the United States, individuals aged 65 years and older increased by 25% to 44.7 million between the years of 2003–2013, and growth estimates suggest that this will more than double by the year 2060 (Administration on Aging, 2014). Chronic pain is exceptionally common among older adults (Molton & Terrill, 2014), and has been shown to increase with age (Donald & Foy, 2004). Chronic low back pain (CLBP) in particular is the leading type of musculoskeletal pain (Docking et al., 2011; Patel, Guralnik, Dansie, & Turk, 2013), and often persists into extreme old age (Hartvigsen & Christensen, 2008). In comparison to pain-free older adults, those with CLBP have more physical disability and poorer overall mental health (Rudy, Weiner, Lieber, Slaboda, & Boston, 2007).

Age is one of the most critical factors associated with chronic pain. Compared to their younger counterparts, older adults suffer more from CLBP, seek less care (Knauer, Freburger, & Carey, 2010), and are more susceptible to poor pain outcomes, including disability and mortality (Gagliese, 2009). Older adults face numerous barriers in accessing chronic pain care, such as poor communication with health care providers, transportation problems, and psychosocial limitations (Park, Hirz, Manotas, & Hooyman, 2013). It is established that older adults often fail to receive adequate chronic pain treatment (e.g., Chodosh et al., 2004; McNeill, Sherwood, & Starck, 2004). Harkins (2005) proposed two reasons for this inadequacy: (a) in regards to age, pain is viewed as a secondary symptom of various comorbid conditions, with emphasis placed more on treatment of the pathology versus the pain; (b) pain may be misunderstood as a "normal" feature of aging, thus, ignored by health care providers.

Though older adults are largely neglected from pain research (Gagliese, 2009; Melding, 1991), a body of qualitative work on chronic pain in this population is amassing. While some studies examined "successful aging" (Collis & Waterfield, 2015) and perceived good health (Richardson, Grime, & Ong, 2014) despite living with chronic pain in old age, most qualitative studies have documented the negative consequences of pain. Research indicates older adults living with chronic pain experience considerable impairment with regard to both their physical functioning (Wilcox et al., 2006) and social activity/engagement (Sofaer-Bennett et al., 2007). Furthermore, issues such as grief and loss (Gran, Festvåg, & Landmark, 2010), perceived vulnerability (Manoochehri, Shirazi, Tafreshi, & Zayeri, 2014), and purposelessness in life (Gran et al., 2010) have been identified. In regard to older adults' pain, Gran and colleagues (2010) noted, "The consequences of suffering was experienced in the feeling of personal loss of integrity and was expressed as resignation, loss of initiative, isolation, insecurity, the feeling of being a burden, sadness, and being closed into own pain until death" (p. 29).

Few qualitative studies on older adults with CLBP have been identified overall, and most pertain largely to treatment-related issues such as preferences, reactions to different approaches, and reasons for not seeking treatment (e.g., Edwards et al., 2015; Lyons et al., 2013; Morone, Lynch, Greco, Tindle, & Weiner, 2008; Makris, 2015; Teh et al., 2009). More recent studies, however, have poignantly illustrated the systemic implications (Stensland & Sanders, Under review) and physical, social, and emotional impacts (Makris et al., 2016) of CLBP in older adulthood. Additionally, (see Stensland & Sanders, Under review) reported how older pain clinic patients with CLBP describe and relate to their CLBP.

While these studies offer valuable insight into the broad experience of CLBP among older adults, the present study seeks to expand upon this knowledge by shedding light specifically on key aging concepts such as retirement, housing, health, and independence in the context of CLBP. Examining CLBP through an aging lens contributes a needed perspective, as it uncovers issues unique to a population which suffers greatly from this condition yet remains largely understudied.