Learning Objectives

  1. Differentiate the weak link and the treatment targets in older adults with chronic low back pain.
  2. Articulate realistic treatment expectations for chronic non-cancer pain.
  3. Descrbie a rational stepped care treatment approach for older patients with chronic low back pain.


  • Debra Weiner, MD (CoEPE Director/Principal Investigator, School of Medicine, Division of Geriatric Medicine; School of Medicine, Department of Psychiatry; School of Medicine, Department of Anesthesiology; Clinical and Translational Science Institute; VA Pittsburgh Healthcare System, Geriatric Research Education and Clinical Center)
  • Heiko Spallek, DMD, PhD, MSBA (CIS) (CoEPE Co-Director/Co-Principal Investigator, SChool of Dental Medicine, Office of Faculty Affairs; School of Dental Medicine, Dpeartment of Dental Public Health)
  • Natalia Morone, MD, MS (Co-Investigator, School of Medicine, Division of General Internal Medicine; VA Pittburgh Healthcare System, Geriatric Research Education and Clinical Center)
  • Michael Schneider, DC, PhD(Co-Investigator, Clinical and Translational Science Institute; School of Health and rehabilitiation Sciences/ Depratment of Physical Therapy)
  • Jordan Karp, MD(Co-Investigator, Department of Psychiatry; UPMC Pain Medicine Centre Commons)

Intended Audience

This course has been designed for

  • Medical students in years 1 through 3
  • Advanced undergraduate and years 1 to 2 masters degree nursing students
  • Dental students in year 3
  • Students in year 2 of a doctoral physical therapy degree
  • Pharmacy students in year 3


The case creators wish to thank the following individuals and programs for their guidance and feedback:

  • Carol Washburn, EdD (Senior Instructional Designer, CIDDE, University of Pittsburgh)
  • John Hennon, EdD (Health Educational Specialist, VA Pittsburgh HEalthcare System)
  • Michael Elnicki, MD (Professor of Medicine, School of Medicine, University of Pittsburgh)
  • University of Pittsburgh, School of Medicine, Standardized Patient Program


This curriculum resource was supported with funding from the NIH Pain Consortium, which approves the educational value of the information provided. The authors listed on this resource are responsible for its content, and questions may be directed to their Center of Excellence in Pain Education. The NIH Pain Consortium provides these evidence-based curriculum resources on pain management as a service to academic medical, dental, nursing, pharmacy, and other health professional schools. This resource is for educational purposes and is not intended as medical practice guidelines. Evidence based practices may have changed since the publication of the resource.

Any materials that the National Institutes of Health (NIH) provides are for information purposes only and do not represent endorsement by or an official position of the (NIH) or any Federal agency. Advice on the treatment or care of a patient should be obtained through consultation with a physician who has examined that patient and is familiar with taht patient's medical history. The information, data, opinions, and statements linked to from this website are not necessarily those of the NIH, or any other Federal agency, and should not be interpreted, acted on, or represented as such.

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