Improving Outcomes for Older Veterans with Chronic Back Pain and Depression

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Chronic low back pain is the 2nd most common reason for physician visits; annual related costs exceed $100 billion, and are expected to rise with the aging population. Prior work confirms that back pain in older adults results in significant physical, psychological and social consequences. We also know that depression frequently co-exists with chronic low back pain and complicates management. A feasible, effective behavioral intervention targeting chronic low back pain and comorbid depression in older Veterans is sorely needed. This is especially true for older Veterans where the efficacy and safety of pharmacologic and surgical options are often less favorable than in younger populations. Existing interventions are not adequate or sufficient as they have not been specifically focused on older Veterans, nor have they targeted both chronic back pain and depression simultaneously. The goal of this VA CDA-2 proposal is to develop, in an iterative process, a multi- component, health coach-telephone-delivered, behavioral intervention that will ultimately improve outcomes of disability and depression in older Veterans with chronic low back pain and depression. The proposed research has 3 interrelated specific aims: 1) develop a behavioral intervention for the target population of older Veterans with chronic low back pain and depression using input from expert, patient and other stakeholder groups; 2) pre-test and refine the intervention in an iterative process by conducting the behavioral intervention in a sample of 10 older Veterans who, along with other stakeholders, will provide feedback on intervention content and delivery; and, 3) conduct a pilot randomized control trial to evaluate feasibility of study procedures and outcome measurement. Dr. Makris' career goals are to become an independent investigator and a national leader with expertise in improving outcomes in medically complex older Veterans with chronic low back pain. She has assembled an exceptional team of mentors who are leaders in outcomes research, geriatrics, behavioral intervention development, evaluation and implementation. During the award period, the applicant will gain skills in behavioral intervention development, qualitative methods, stakeholder engagement, comparative effectiveness and implementation research methods. As a rheumatologist focused on aging research, and with her commitment to improving outcomes in older Veterans, this award would prepare Dr. Makris to lead efforts nationally to develop non-pharmacologic management approaches to improve patient reported outcomes for medically complex older Veterans with chronic low back pain and comorbid depression.