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Practice Practice Pointer

Low back pain in people aged 60 years and over

BMJ 2022; 376 doi: (Published 22 March 2022) Cite this as: BMJ 2022;376:e066928
  1. Adrian C Traeger, research fellow1,
  2. Martin Underwood, professor of primary care research23,
  3. Rowena Ivers, general practitioner, associate professor4,
  4. Rachelle Buchbinder, rheumatologist, professor56
  1. 1School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
  2. 2Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
  3. 3University Hospitals Coventry and Warwickshire, Coventry, UK
  4. 4Graduate Medicine, University of Wollongong, Wollongong, Australia
  5. 5Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
  6. 6Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
  1. Correspondence to: A Traeger adrian.traeger{at}

What you need to know

  • Non-specific low back pain is common in people ≥60 years old; however, the index of suspicion for specific causes is higher than in younger people

  • Unfavourable benefit-harm profiles of pain medicines for non-specific low back pain is likely worse for people ≥60 years old than younger people

  • Consider individual patients’ previous treatment experiences, values, and preferences

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.

Why does low back pain matter in people ≥60 years old?

Globally, low …

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