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Testing a Personalized Approach to Chronic Low Back Pain: A Randomized Controlled Trial in Older Veterans.

Debra K Weiner^1,2, Angela Gentili^3,4, Meika A Fang^5,6

¹Geriatric Research, Education and Clinic Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.

Arthritis Care & Research

|October 21, 2025

Summary

Personalized Aging Back Clinics (ABC) care for older Veterans with chronic low back pain showed preliminary benefits in physical function and pain reduction, though not on the primary disability measure.

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Area of Science:

Gerontology
Pain Management
Clinical Research

Background:

Chronic low back pain (CLBP) significantly impacts older adults, affecting their quality of life and independence.
Current usual care (UC) for CLBP in Veterans may not fully address the multifaceted nature of the condition in older populations.

Purpose of the Study:

To evaluate the efficacy of personalized treatment for older Veterans with CLBP delivered by Aging Back Clinics (ABC) compared to usual care (UC).

Main Methods:

A randomized controlled trial involving 299 Veterans (age 65-89) with CLBP from three VA medical centers.
ABC care utilized physician-guided algorithms targeting specific conditions contributing to CLBP; UC was managed by primary care providers.
The primary outcome was the Oswestry Disability Index (ODI) change at 6 months, with secondary outcomes including pain, quality of life, physical function, falls, and healthcare utilization over 12 months.

Main Results:

No significant group differences were found in the primary outcome, Oswestry Disability Index (ODI) change.
The ABC group demonstrated greater improvements in self-reported physical function (PROMIS-29) and physical/mental health (PROMIS Global) at 12 months.
The ABC group also showed significant reductions in average and worst pain intensity and marginally fewer falls over 12 months.

Conclusions:

Personalized care via Aging Back Clinics (ABC) did not demonstrate superiority over usual care (UC) in improving the primary disability measure (ODI) for older Veterans with CLBP.
Preliminary evidence suggests ABC care may offer benefits in improving self-reported physical health, reducing pain, and potentially decreasing falls in this population.