# Optimizing Outcomes for Older Veterans with Chronic Low back Pain Syndrome: Aging Back Clinics

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

The purpose of the proposed clinical trial is to improve the care of older Veterans (age 65+) with chronic low
back pain (CLBP, i.e., low back pain for at least 6 months on at least half the days). Current CLBP care is
limited by being either overly spine-focused or generically prescribed. Spine-focused care often targets
degenerative disease of the lumbar spine (e.g., degenerative disc/facet disease, disc bulge) that is nearly
ubiquitous in older adults, even those who are pain-free. Generic CLBP care typically consists of physical
therapy and oral analgesics, and many analgesics have potentially serious side effects in older adults such as
gastrointestinal bleeding and hip fracture. Both spine-focused care and generic care often result in suboptimal
improvement in pain and function. Through prior VA funding, we have laid the essential foundation for a
patient-centered approach to care for older Veterans with CLBP, Aging Back Clinics (ABCs), in which the spine
is a source of vulnerability but not the sole treatment target. ABCs approach CLBP as a geriatric syndrome,
that is, a final common pathway for the expression of multiple contributors, not a disease of the spine. In our
prior work we have: 1) Collaborated with 42 pain experts and primary care providers using a modified Delphi
approach to develop 12 evidence-based, older adult-tailored evaluation and treatment algorithms for important
conditions that contribute to pain and disability in older adults with CLBP, i.e., hip osteoarthritis, fibromyalgia,
maladaptive coping, leg length discrepancy, anxiety, depression, myofascial pain, insomnia, sacroiliac joint
syndrome, lateral hip/thigh pain (e.g., greater trochanteric pain syndrome), lumbar spinal stenosis, dementia.
2) Established the commonplace nature of these contributors in older Veterans. 3) Verified the feasibility and
acceptability of ABC care to VA providers and Veterans. 4) Used iterative usability testing to develop an
interactive tool, Take Back Your Back, that efficiently screens for non-musculoskeletal conditions (i.e.,
maladaptive coping, depression, anxiety, insomnia, fibromyalgia), and educates patients about realistic
treatment expectations and CLBP as a biopsychosocial syndrome rather than a disease of the spine. The
proposed randomized controlled clinical trial is designed to test the efficacy of ABCs as compared with Usual
Care. Three hundred thirty Veterans age 65-89 (110 from each of 3 sites – VA Pittsburgh Healthcare System,
Dallas VA, Hunter Holmes McGuire [Richmond] VA) with CLBP and no red flags indicative of serious
underlying illness will be randomized to ABCs or UC for 3 months and followed for 12 months after
randomization. The ABCs will be virtual clinics staffed by consultants (e.g., geriatrics, pain medicine,
rheumatology) trained in working with our algorithms who will refer patients to other providers (e.g., physical
therapy, Behavioral Health, chiropractic) as needed. Usual care will not be constrained. Ba...

## Key facts

- **NIH application ID:** 9985637
- **Project number:** 5I01RX002808-03
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** DEBRA KAYE WEINER
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-10-01 → 2023-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9985637

## Citation

> US National Institutes of Health, RePORTER application 9985637, Optimizing Outcomes for Older Veterans with Chronic Low back Pain Syndrome: Aging Back Clinics (5I01RX002808-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9985637. Licensed CC0.

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