[Lumbar pain in old age]

In advanced age, lumbar pain is less frequently caused by occupational stress and psychosomatic factors. Unstable segments and spondylo-arthrotic degeneration can lead to muscular strain whenever insufficient secondary stability and missing muscular equilibrium are involved. In the differential diagnosis one must distinguish between osteoporosis and spinal stenosis, which increases in frequency with age. Pain due to internal or gynecological problems must be excluded. From the therapeutic point of view, patients should be instructed in ergonomics and the simple application of physiotherapeutic procedures, e.g. heat and cold. Analgetics become increasingly important with age, consequently resulting in reduced use of antirheumatics. There exists enough evidence to show that muscular training of the lumbar muscles play an important role in the secondary prevention of lumbar pain in elderly people as well. Essentially, it can be stated that physical age is not directly related to possible ailment. The change of occupational obligations, with possibilities to adapt to personal stress levels, as well as the positive attitude towards everyday life in retirement have a major influence in accepting and handling ability of problems, concerning pain. In the department of Physical Medicine, Rehabilitation and Rheumatology of the Clinic Wilhelm Schulthess it was found that among 7806 patients with lower back pain (1990-1995) 43.3% involved the ages of 40 to 60 and 31.3% the ages of 60 to 80. More distinctly than in younger patients, older aged patients tend to show a marked discrepancy between radiological findings and effective pain. Lower back pains of elderly patients are of a different nature from those found in younger or middle-aged people. Ischialgia due to the protrusion of an intervertebral disk or an acute lumbovertebral syndrome caused by muscular instability are found much less frequently.