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Epidemiology of Low Back Pain in Adults

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Objective:

Low back pain affects many individuals. It has profound effects on well-being and is often the cause of significant physical and psychological health impairments. Low back pain also affects work performance and social responsibilities, such as family life, and is increasingly a major factor in escalating health-care costs. A global review of the prevalence of low back pain in the adult general population has shown its point prevalence to be approximately 12%, with a one-month prevalence of 23%, a one-year prevalence of 38%, and a lifetime prevalence of approximately 40%. Furthermore, as the population ages over the coming decades, the number of individuals with low back pain is likely to increase substantially. This comprehensive review is undertaken to assess the increasing prevalence of low back pain and the influence of comorbid factors, along with escalating costs.

Materials and Methods:

A narrative review with literature assessment.

Results:

In the USA, low back pain and related costs are escalating. Based on the available literature, it appears that the prevalence of low back pain continues to increase, along with numerous modalities and their application in managing low back pain. Comorbid factors with psychological disorders and multiple medical problems, including obesity, smoking, lack of exercise, increasing age, and lifestyle factors, are considered as risk factors for low back pain.

Conclusion:

Although it has been alleged that low back pain resolves in approximately 80% to 90% of patients in about six weeks, irrespective of the administration or type of treatment, with only 5% to 10% of patients developing persistent back pain, this concept has been frequently questioned as the condition tends to relapse and most patients experience multiple episodes years after the initial attack.

Section snippets

INTRODUCTION

Spinal disorders, especially low back pain, affect many people and have a negative impact on work capacity and on the overall well-being of an individual. Coupled with escalating health-care costs, low back pain frequently results in a significant impairment of physical and psychological health, and a decline in the performance of social responsibilities including work and family (1., 2., 3., 4., 5., 6., 7., 8., 9., 10., 11., 12., 13., 14., 15., 16.). Consequently, low back pain remains one of

PREVALENCE

A global review of the prevalence of low back pain in the adult general population was published in 2012 (2). It showed a point prevalence of 11.9% ± 2.0% and a one-month prevalence of 23.2% ± 2.9% after adjusting for methodological variation. The overall mean prevalence was 31.0% ± 0.6%, the one-year prevalence was 38.0% ± 19.4%, and the lifetime prevalence was 39.9% ± 24.3%. Low back pain was shown to be a major problem throughout the world, with the highest prevalence among women and those

COURSE AND PROGNOSIS

The duration of back pain and its chronicity have been debated. It is widely believed that most episodes are short-lived, with 80% to 90% of attacks resolving in about six weeks, irrespective of the administration or type of treatment, with only 5% to 10% of patients developing persistent back pain (52,53). However, this concept has been frequently examined, as the condition tends to relapse and because most patients will experience multiple episodes (18,54., 55., 56., 57., 58., 59., 60., 61.,

RISK FACTORS

Low back pain is a multifactorial disorder with many possible etiologies. Consequently, to analyze the various risk factors of low back pain and dissect this 20th-century health-care enigma, many epidemiologic studies have focused on risk factors for low back pain, attempting to analyze occupational, nonoccupational, and psychosocial factors (1,3,4,6,18,20,21,34,64., 65., 66., 67., 68., 69., 70., 71., 72., 73., 74., 75., 76., 77.). Cohen et al. (71) concluded that the risk factors for

HEALTH AND ECONOMIC IMPACT

Low back pain is associated with significant economic, societal, and health outcomes (8., 9., 10., 11., 12., 13., 14., 15.,17,18,28,30., 31., 32., 33.,40,45,78,95., 96., 97., 98.,120., 121., 122., 123., 124., 125., 126., 127., 128., 129., 130., 131., 132.).

Leigh (10), in a 2011 publication assessing data from 2007, evaluated the economic burden of occupational injury and illness in the USA. In this updated evaluation he showed that the costs were more than $290 billion. The total estimated

CONCLUSION

Chronic low back pain has a profound effect on each and every facet of human life. The overall costs of managing low back pain are escalating. The evidence shows increasing awareness, prevalence, chronicity, and perceived severity with resulting disability. Multiple comorbid factors including lifestyle and social factors, occupational factors, and psychosocial factors influence overall prevalence and outcomes.

Acknowledgments

The authors wish to thank Vidyasagar Pampati, MSc, for statistical assistance, Sekar Edem for assistance in the search of the literature, Alvaro F. Gómez, MA, for manuscript review, and Tonie M. Hatton and Diane E. Neihoff, transcriptionists, for their assistance in the preparation of this manuscript.

Authorship Statements

Dr. Manchikanti conducted and prepared the manuscript. Drs. Singh, Falco, Benyamin, and Hirsch provided intellectual input and edits to the manuscript. All authors had final approval of the

REFERENCES (134)

  • Hamberg-van ReenenHH et al.

    A systematic review of the relation between physical capacity and future low back and neck/shoulder pain

    Pain

    (2007)
  • AzevedoLF et al.

    Epidemiology of chronic pain: a population-based nationwide study on its prevalence, characteristics and associated disability in Portugal

    J Pain

    (2012)
  • TruchonM et al.

    Low-back-pain related disability: an integration of psychological risk factors into the stress process model

    Pain

    (2008)
  • BattiéMC et al.

    The Twin Spine Study: contributions to a changing view of disc degeneration

    Spine J

    (2009)
  • LeighJP et al.

    Lifestyle risk factors predict healthcare costs in an aging cohort

    Am J Prev Med

    (2005)
  • LintonSJ.

    Do psychological factors increase the risk for back pain in the general population in both a cross-sectional and prospective analysis?

    Eur J Pain

    (2005)
  • ManchikantiL et al.

    Comprehensive review of epidemiology, scope, and impact of spinal pain

    Pain Physician

    (2009)
  • HoyD et al.

    A systematic review of the global prevalence of low back pain

    Arthritis Rheum

    (2012)
  • BriggsAM et al.

    Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain: an assessment of health literacy

    BMC Musculoskelet Disord

    (2011)
  • GignacMA et al.

    “What do you expect? You’re just getting older”: a comparison of perceived osteoarthritis-related and aging-related health experiences in middle- and older-age adults

    Arthritis Rheum

    (2006)
  • Leboeuf-YdeC et al.

    Pain in the three spinal regions: the same disorder? Data from a population-based sample of 34,902 Danish adults

    Chiropr Man Therap

    (2012)
  • MartinBI et al.

    Expenditures and health status among adults with back and neck problems

    JAMA

    (2008)
  • MartinBI et al.

    Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997–2006

    Spine

    (2009)
  • LeighJP.

    Economic burden of occupational injury and illness in the United States

    Milbank Q

    (2011)
  • BhushanA et al.

    National trends in occupational injuries before and after 1992 and predictors of workers’ compensation costs

    Public Health Rep

    (2011)
  • AscheCV et al.

    societal costs of low back pain: data published between 2001 and 2007

    J Pain Palliat Care Pharmacother

    (2007)
  • BeckerA et al.

    Low back pain in primary care: costs of care and prediction of future health care utilization

    Spine

    (2010)
  • PryceR et al.

    Relationship between ambulatory performance and self-rated disability in patients with lumbar spinal stenosis

    Spine

    (2012)
  • Kelly-HayesM et al.

    Functional limitations and disability among elders in the Framingham Study

    Am J Public Health

    (1992)
  • CecchiF et al.

    Epidemiology of back pain in a representative cohort of Italian persons 65 years of age and older: the InCHIANTI study

    Spine

    (2006)
  • BresslerHB et al.

    The prevalence of low back pain in the elderly. A systematic review of the literature

    Spine

    (1999)
  • DionneCE et al.

    Does back pain prevalence really decrease with increasing age? A systematic review

    Age Ageing

    (2006)
  • DeyoRA et al.

    Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002

    Spine

    (2006)
  • CassidyJD et al.

    The Saskatchewan Health and Back Pain Survey. The prevalence of low back pain and related disability in Saskatchewan adults

    Spine

    (1998)
  • NachemsonAL.

    Newest knowledge of low back pain. A critical look

    Clin Orthop

    (1992)
  • LeighJP et al.

    Occupational injury and illness in the United States. Estimates of costs, morbidity, and mortality

    Arch Intern Med

    (1997)
  • GuoHR et al.

    Back pain among workers in the United States. National estimates and workers at high risk

    Am J Ind Med

    (1995)
  • RautiainenRH et al.

    Cost of compensated injuries and occupational diseases in agriculture in Finland

    J Agromedicine

    (2005)
  • LeighJP et al.

    Occupational disease and workers’ compensation: coverage, costs, and consequences

    Milbank Q

    (2004)
  • WaehrerG et al.

    Costs of occupational injury and illness across states

    J Occup Environ Med

    (2004)
  • LeighJP et al.

    Costs differences across demographic groups and types of occupational injuries and illnesses

    Am J Ind Med

    (2006)
  • DunningKK et al.

    Costs by industry and diagnosis among musculoskeletal claims in a state workers compensation system: 1999–2004

    Am J Ind Med

    (2010)
  • FreburgerJK et al.

    The rising prevalence of chronic low back pain

    Arch Intern Med

    (2009)
  • Behavioral Risk Factor Surveillance System: centers for Disease Control

    (2008)
  • KerrMS et al.

    Biomechanical and psychosocial risk factors for low back pain at work

    Am J Public Health

    (2001)
  • Mailis-GagnonA et al.

    Pain characteristics of adults 65 years of age and older referred to a tertiary care pain clinic

    Pain Res Manag

    (2008)
  • RaspeH et al.

    Back pain, a communicable disease?

    Int J Epidemiol

    (2008)
  • Annual Statistical Report on the Social Security Disability Insurance Program, 2011

    (2011)
  • DeyoRA et al.

    Overtreating chronic back pain: time to back off?

    J Am Board Fam Med

    (2009)
  • ManchikantiL et al.

    Opioid epidemic in the United States

    Pain Physician

    (2012)
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