Deconstructing Chronic Low Back Pain in the Older Adult-Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment: Part VII: Insomnia

Pain Med. 2016 May;17(5):851-63. doi: 10.1093/pm/pnw063.


OBJECTIVE : To present the seventh in a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults. This article focuses on insomnia and presents a treatment algorithm for managing insomnia in older adults, along with a representative clinical case. METHODS : A modified Delphi process was used to develop the algorithm and supportive materials. A multidisciplinary expert panel representing expertise in health psychology and sleep medicine developed the algorithm and supporting documents that were subsequently refined through an iterative process of input from a primary care provider panel. RESULTS : We present an illustrative clinical case and an algorithm to help guide the care of older adults with insomnia, an important contributor to CLBP and disability. Multicomponent cognitive behavioral therapy for insomnia (CBTI) and similar treatments (e.g., brief behavioral treatment for insomnia [BBTI]) are the recommended first-line treatment. Medications should be considered only if BBTI/CBTI is suboptimal or not effective and should be prescribed at the lowest effective dose for short periods of time (< 90 days). CONCLUSIONS : Insomnia is commonly comorbid with CLBP in older adults and should be routinely evaluated and treated because it is an important contributor to pain and disability. The algorithm presented was structured to assist primary care providers in planning treatment for older adults with CLBP and insomnia.

Keywords: Chronic Low Back Pain; Chronic Pain; Elderly; Insomnia; Low Back Pain; Older Adults; Sleep Disorders.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Aged
  • Algorithms
  • Chronic Pain / complications
  • Chronic Pain / diagnosis
  • Chronic Pain / therapy*
  • Cognitive Behavioral Therapy / methods
  • Delphi Technique*
  • Expert Testimony / methods*
  • Humans
  • Low Back Pain / complications
  • Low Back Pain / diagnosis
  • Low Back Pain / therapy*
  • Male
  • Sleep Initiation and Maintenance Disorders / diagnosis
  • Sleep Initiation and Maintenance Disorders / etiology
  • Sleep Initiation and Maintenance Disorders / therapy*
  • Surveys and Questionnaires
  • Trazodone / therapeutic use
  • Treatment Outcome


  • Trazodone