The Reality of Lower Back Pain in Older Adults

Back Pain in Older Adults

Introduction and Statistics

As our healthcare has improved and advanced in our country, our life expectancy has increased. The average life expectancy at birth in the United States was 78.8 for males and 80.5 for females in 2019. In addition to the longer life span from medical advances, our population is growing, specifically for individuals 65 and older. Lower back pain is one of the most common health issues in older adults and studies show that 36 to 70% of older adults over the age of 65 suffer from back pain (Wong, Karppinen, & Samartzis, 2017). Up to 80% of older adults that reside in long-term care facilities suffer from musculoskeletal pain with one-third of them suffering from lower back pain, and the likelihood of experiencing lower back pain increases with older age (Wong, Karppinen, & Samartzis, 2017). The concern of increasing lower back pain as we age is that many older adults go inadequately treated or their pain is underreported. Left untreated, older adults with lower back pain may experience sleep disturbances, withdrawal from social and recreational activities, psychological distress, impeded cognition, malnutrition, deterioration of functional ability, and falls (Wong, Karppinen, & Samartzis, 2017). We will continue to unpack the causes of this lower back pain as we age and possible treatments to experience maximum relief from this debilitating issue.

Causes and Risk Factors

The causes of lower back pain in older adults can be difficult for physicians to diagnose therefore leading to inappropriate or less-than-effective treatments. Many factors can lead to severe and/or chronic back pain in older adults. Better understanding of these factors can help physicians determine more effective treatments.  Unfortunately, many older adults experiencing lower back pain have no specific pathology, and the pain may be altered by posture, activity, or time of day. The diagram below shows the different risks factors (non-modifiable and modifiable) as well as the assessments and treatments that lead to severe or chronic low back pain in older adults. Some non-modifiable risk factors include gender as women are more prone to experience lower back pain than males and prior work exposures to lifting, bending, twisting, and stooping (Wong, Karppinen, & Samartzis, 2017). Some modifiable risk factors include psychological distress, such as anxiety or depression, moderate or vigorous physical activity, smoking, and co-morbidities (Wong, Karppinen, & Samartzis, 2017).

Figure 1. Wong, A. Y., Karppinen, J., & Samartzis, D. (2017). Low back pain in older adults: risk factors, management options and future directions. Scoliosis and spinal disorders, 12, 14.

Assessments and Possible Treatments

Since older adults usually experience both age-related physical and psychosocial issues, comprehensive assessments and treatments are needed to effectively manage lower back pain in older adults. When healthcare professionals understand the many factors that contribute to severe and chronic lower back pain in older adults, timely and proper treatment strategies can be created. In a clinic setting, we utilize the 11-point system where 0 indicates no pain and 10 indicates the most severe pain. Other potential self-assessment pain reporting tools include the Faces Pain Scale using facial expressions instead of numbers to describe pain. This scale was preferred over the numeric scale for African American and Chinese older adults (Wong, Karppinen, & Samartzis, 2017). Observational pain assessments and input from family members can also be utilized to provide better pain management, especially those that suffer with diseases that prevents them to communicate their pain levels accurately or verbally, such as dementia or aphasia post-stroke.

After healthcare providers complete an accurate assessment of the older adult’s pain, different treatments can be introduced to address the lower back pain. Medications are one treatment method, such as a standing order of analgesic (e.g. acetaminophen) for older adults with chronic pain with non-steroidal anti-inflammatory drugs (NSAIDs) being prescribed if acetaminophen can’t manage the pain (Wong, Karppinen, & Samartzis, 2017).  Other medications, such as opioids, can lead to increased falls and other side effects in older adults, such as depression, nausea, seizures, etc.; therefore, caution is advised for prescribing them for pain management in older adults. Other conservative approaches are recommended, such as physical therapy and Tai Chi (Wong, Karppinen, & Samartzis, 2017).  While surgery is an option to manage this type of pain in older adults, some patients may continue to experience lower back pain even after surgery. Research shows that Spinal Cord Stimulation (SCS) may be more effective in managing this pain with moderate effectiveness. As with any treatment, clinicians should consider the benefits and risks of different treatment options for their patients experiencing lower back pain and tailor the approach to that specific individual.

Are you an older adult that is concerned about your persistent lower back pain? Call Dr. Nemeth today at 843-730-4124 to learn about your treatment options with a conservative approach to get your life back.


Wong, A. Y., Karppinen, J., & Samartzis, D. (2017). Low back pain in older adults: risk factors, management options and future directions. Scoliosis and spinal disorders12, 14.

Signe Spine Team Contributor

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