Back pain is one of the most common health complaints in the United States and around the world. While almost everyone will have back pain at some time in their life, low-back pain is more prevalent in people 40 to 80 years old, and in women. Back pain is due in part to the aging process, but also as a result sedentary life styles with too little (sometimes punctuated by too much) exercise.
The risk of experiencing low-back pain from disc disease or spinal degeneration increases with age. However, most of the time, the exact cause of the pain cannot be found. Low-back pain is also the most common cause of job-related disability and a leading contributor to missed work.
Acute or short-term back pain generally lasts from a few days to a few weeks. Most acute back pain is mechanical in nature – the result of trauma to the lower back or arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones or tissues. Symptoms may ranges from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to stand straight. Occasionally, pain felt in one part of the body may “radiate” from a disorder or injury elsewhere in the body. Some acute pain syndromes can become more serious if left untreated. Chronic back pain is often progressive and the cause can be difficult to determine.
Psychological factors are believed to influence the development of chronic low-back pain (LBP). The Fear Avoidance Model is commonly used to explain how psychological factors affect the experience of pain and the development of chronic pain and disability. It is theorized that for some individuals with LBP, negative beliefs about pain and/or negative illness information leads to a catastrophizing response in which the worst possible outcome of activity is imagined. This leads to fear of activity and avoidance which in turn cause disuse and resultant distress, reinforcing the original negative appraisal in a deleterious cycle. The fear avoidance model suggests that patients without fear avoidance beliefs are more likely to confront pain problems and are more active in the coping process. This type of “good” coping has been used to develop interventions for those with high fear avoidance beliefs.
One study found that in patients with low-back pain of up to six months duration, high fear avoidance beliefs were associated with more pain and/or disability and less return to work.
It is generally accepted that the experience of back pain is shaped at a biopsychological level. One area of research interest is the social impact of back pain, in particular the influence of patients’ pain and related outcomes on their partners’ (e.g. spouse) distress and relationship quality. Research shows chronic pain can have a negative impact on the relationship quality between patient and partner, and this can have a reciprocal influence on patient outcomes.
- Back pain affects 8 out of 10 people at some point during their lives.
- Approximately one quarter of U.S. adults reported have low-back pain lasting at least one whole day in the past three months and 7.6% reported at least one episode of severe acute low-back pain within a one-year period.
- When respondents were asked if they have experienced low-back pain, severe headache or migraine, or neck pain in the past three months, a National Institutes of Health statistics survey indicated that low-back pain was the most common (27.5%), followed by severe headache or migraine pain (14.2%) and neck pain (13.9%).
- Adults with low-back pain are often in worse physical and mental health than people who do not have low-back pain; 28% of adults with low-back pain reported limited activity due to a chronic condition, as compared to 10% of adults who do not have low-back pain. Also, adults reporting low-back pain were three times as likely to be in fair or poor health and more than four times as likely to experience serious psychological distress as people without low-back pain
- In cross-sectional studies, current smoking was associated with increased prevalence of low-back pain in the past month, low-back pain in the past 12 months, seeking care for low-back pain, chronic low-back pain, and disabling low-back pain. Former smokers had a higher prevalence of low-back pain compared with never smokers, but a lower prevalence of low-back pain current smokers.
- One study evaluating pain and sleep found the estimated prevalence of sleep disturbance was 58.7% among people with low-back pain. Sleep disturbance was found to be dependent on pain intensity, where each increase by one point on a ten-point scale was associated with a 10% increase in the likelihood of reporting sleep disturbance.
BACK PAIN IN COMBINATION WITH OTHER PAIN
Research has found that patients with chronic low-back pain with a neuropathic component were more often women, were older, and were more likely to have clinically diagnosed depression, and made significantly greater use of health care resources.
One study found that when people with chronic low-back pain also report widespread pain, they report significantly more impaired body functions, more severe activity limitations, and participation restrictions. Environmental factors, health-related aspects were also negatively impacted. More severe clinical stress symptoms and risk for future disability were registered among study participants who had widespread pain in addition to chronic low-back pain.
Patients with both chronic low-back pain and widespread pain showed more impaired physical performance, higher numbers of tender points, more severe pain, fatigue, and depression compared with those with chronic low-back pain alone. Work disability was 35% in the group with low-back pain and widespread pain compared to 16% without chronic low-back pain.
BACK PAIN AND PREGNANCY
- One in three women in the world experience back pain induced during pregnancy with the number of previous deliveries as a strong predictor. Other known determinants of pregnancy-induced back pain include early menarche, hormonal contraceptive use before first pregnancy, physically demanding work, and emotional distress. In addition, hormonal and reproductive factors have been associated with risk of chronic low-back pain. In most women, the back pain disappears soon after delivery. However, about 8% of women experience disabling pregnancy-induced back pain that continues several years after delivery.
- Numerous women suffering from pregnancy-related low-back pain experience difficulties performing normal daily activities such as prolonged sitting and/or getting up from sitting positions, turning over in bed, dressing/undressing, walking, lifting, and carrying small weights.
- Pelvic girdle pain in pregnancy has been estimated to affect about half of pregnant women, where 25% experience serious pain and 8% experience severe disability. This can be compared to 6.3% among non-pregnant women in the same age group.
- Research has found an increased probability of recurrent and continuous pain at 14 months post-delivery in women who had experienced low-back pain before their pregnancy, as compared to women who had not previously experienced it. The most commonly reported pain characteristics were dull, stabbing, and cutting pain.
- The results from one study demonstrate that persistent pregnancy-related low-back pain and pelvic girdle pain is a major individual and public health issue among women 14 months postpartum, which negatively affects self-reported health.
BACK PAIN AND RACE
One state-based survey of chronic, disabling back pain found that the prevalence in North Carolina was similar between black and white populations at 10.4% and 9.8%. Prevalence was lower among Latinos (6.3%), but the Latino population in North Carolina is much younger than that of other ethnic groups. The prevalence of chronic neck pain (without chronic back pain) was greater in whites.
Consistent with characteristics of the general population, blacks and Latinos with chronic back and neck pain were of somewhat lower educational status, younger, and much more likely to be poor (family income less than $20,000 per year). Blacks were more likely to receive Medicaid and disability payments either through Medicare (i.e. Medicare and <62 years) or other types of disability insurance.
Blacks with chronic back or neck pain had higher pain scores and worse functional status, greater number of bed days in the past month, and lower mental health scores. Blacks were also more likely to perceive extremity weakness. The Latino group was less likely to have received spine surgery in the past and there was a similar trend with blacks. Latinos also reported somewhat higher pain intensity, but fewer problems with physical function, compared to whites.
COST OF BACK PAIN
- Total direct costs of chronic low-back pain-related health care utilization are estimated to be $96 million a year; chronic low-back pain with a neuropathic component accounted for 96% of total costs; the mean annual cost of care per patient was 160% higher than chronic low-back pain patients without a neuropathic component ($2,577 vs. $1,007).
- On average, health care expenditures for individuals with back pain have been estimated to be about 60% higher than those without back pain.
- One review of published literature found that the largest proportion of direct medical costs for low-back pain are physical therapy (17%) and inpatient services (17%), followed by pharmacy (13%) and primary care (13%).
- Approximately 5% of the people with back pain disability account for 75% of the costs associated with low-back pain.
- According to the U.S. Bureau of Labor Statistics, in 2012, there were 217,660 work related cases involving injuries to the back. This represents 21.2% of reported workplace injuries.
- Indirect costs related to days lost from work are substantial, with approximately 2%of the U.S. work force compensated for back injuries each year.
- American Academy of Orthopedic Surgeons
- American Chronic Pain Association
- American Osteopathic Association
- National Institute of Arthritis and Musculoskeletal Diseases
- American Chiropractic Association