Karp Jordan F, DiNapoli Elizabeth A, Wetherell Julie, Bolon Chloe, Rodriguez Eric, Shega Joseph, Weiner Debra K
*Geriatric Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania Department of Psychiatry Department of Anesthesiology Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Psychiatry Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
Pain Med. 2016 Aug;17(8):1423-35. doi: 10.1093/pm/pnw135. Epub 2016 Jun 26.
As a part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on anxiety-a significant contributor of reduced health-related quality of life, increased use of medical services, and heightened disability in older adults with CLBP.
A modified Delphi technique was used to develop an algorithm for the screening and clinical care of older adults with CLBP and anxiety. A 4-member content expert panel and a nine-member primary care panel were involved in this iterative development process. Evidence underlying the recommendations is not strictly based on VA populations; therefore, the algorithm can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributor's clinical practice.
We present a treatment algorithm and supporting tables to be used by providers treating older adults who have anxiety and CLBP. A case of an older adult with anxiety and CLBP is provided to illustrate the approach to management.
To promote early engagement in evidence-based treatments, providers should routinely evaluate anxiety in older adults with CLBP using a screening and treatment algorithm.
作为旨在剖析老年人慢性腰痛（CLBP）系列文章的一部分，本文聚焦于焦虑——这是导致老年人CLBP患者健康相关生活质量下降、医疗服务使用增加以及残疾加剧的一个重要因素。
采用改良的德尔菲技术来制定针对患有CLBP和焦虑症的老年人的筛查及临床护理算法。一个由4名成员组成的内容专家小组和一个由9名成员组成的初级保健小组参与了这一迭代开发过程。这些建议所依据的证据并非严格基于退伍军人事务部（VA）人群；因此，该算法可应用于退伍军人健康管理局（VHA）和民用环境。示例临床病例取自其中一位作者的临床实践。
我们展示了一种治疗算法和辅助表格，供治疗患有焦虑症和CLBP的老年人的医疗服务提供者使用。提供了一个患有焦虑症和CLBP的老年人病例，以说明管理方法。
为促进早期参与循证治疗，医疗服务提供者应使用筛查和治疗算法对患有CLBP的老年人的焦虑症进行常规评估。
