Epidemiology of low back pain

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Summary

At present, although there have been many epidemiological studies of risk factors for low back pain, there are few risk factors established in prospective studies; and our understanding of them remains relatively crude.

Individuals in jobs requiring manual materials handling, particularly repeated heavy lifting and lifting while twisting, are at increased risk of back pain leading to work absence. In addition, exposure to whole-body vibration and job requirements for static postures are associated with back pain. Individual trunk strength has not been consistently demonstrated as associated with back pain; although there is some suggestion that when work requirements for heavy lifting exceed individual capacities, back pain is more likely to occur. The pattern of peak age at onset in the 20's is consistent with back pain development early in working life. Among other individual characteristics, only cigarette smoking has consistently been associated with back pain; and the biological mechanism for this finding is not understood. Evidence with respect to spinal flexibility, aerobic capacity, educational attainment and other variables is suggestive but not consistent. There is some evidence that the individual's relation to work, expressed as job satisfaction or supervisor rating, is also related to work absence due to back pain.

While it is possible to describe, however crudely, the characteristics placing people at risk for back pain leading to work absence and/or medical attention, the problem of predicting chronicity and thus identifying patients for more intensive clinical intervention remains unresolved. At this time, only age of the patient and certain clinical features of the back pain such as the presence of sciatic symptoms, duration of the current episode, and history of prior episodes are consistently demonstrated predictors. In chronic patients, there is suggestive evidence that spinal flexibility, trunk strength, and certain psychological characteristics such as coping skills, fear and avoidance of pain or movement, job satisfaction, attribution of fault and hysterical or hypochondriacal features are associated with treatment failure. In addition, there is suggestive evidence that the availability of alternative work placement may allow for earlier return to work than otherwise. While the availability of disability compensation in excess of usual wages may serve as a disincentive to return to work. The latter-cited remain to be verified, while findings in chronic patients remain to be tested in acute. Further, the role of physical demands of work in duration of back pain episodes has not been well studied.

References (92)

  • HaberLD

    Disabling effects of chronic disease and impairment

    Journal of Chronic Diseases

    (1971)
  • HeliovaaraM

    Occupation and risk of herniated lumbar disc or sciatica leading to hospitalization

    Journal of Chronic Diseases

    (1987)
  • LoveA et al.

    The MMPI and psychological factors in chronic low back pain: a review

    Pain

    (1987)
  • AbenhaimL et al.

    Importance and economic burden of occupational back pain: a study of 2500 cases representative of Quebec

    Journal of Occupational Medicine

    (1987)
  • AnderssonGBJ

    The epidemiology of spinal disorders

  • AnderssonGBJ et al.

    The intensity of work recovery in low back pain

    Spine

    (1983)
  • BarkerME

    Pain in the back and leg: a general practice survey

    Rheumatology and Rehabilitation

    (1977)
  • BattieMC et al.

    Isometric lifting strength as a predictor of industrial back pain

    Spine

    (1989)
  • BattieMC et al.

    A prospective study of the role of cardiovascular risk factors and fitness in industrial back complaints

    Spine

    (1989)
  • BattieMC et al.

    The role of spinal flexibility in back pain complaints within industry: a prospective study

    Spine

    (1990)
  • BattieMC et al.

    Anthropometric and clinical measurements as predictors of industrial back pain complaints: a prospective study

    Journal of Spinal Disorders

    (1990)
  • BennRT et al.

    Pain in the back: an attempt to estimate the size of the problem

    Rheumatology and Rehabilitation

    (1975)
  • BergenuddH et al.

    Somatic versus nonsomatic shoulder and back pain experience in middle age in relation to body build, physical fitness, bone mineral content, gamma-glutamyltransferase, occupational workload, and psychosocial factors

    Spine

    (1991)
  • BergenuddH et al.

    Back pain in middle age; occupational workload and psychologic factors: an epidemiologic survey

    Spine

    (1988)
  • BerksonM et al.

    Voluntary strengths of male adults with acute low back syndromes

    Clincial Orthopaedics and Related Research

    (1977)
  • Biering-SorensenF

    A prospective study of low back pain in general population. I. Occurrence, recurrence and etiology

    Scandinavian Journal of Rehabilitative Medicine

    (1983)
  • Biering-SorensenF

    A prospective study of low back pain in a general population. III. Medical service-work consequence

    Scandinavian Journal of Rehabilitative Medicine

    (1983)
  • Biering-SorensenF

    A one-year prospective study of low back pain in a general population

    Danish Medical Bulletin

    (1984)
  • BigosSJ et al.

    Back injuries in industry: a retrospective study: III. Employee-related factors

    Spine

    (1986)
  • BigosSJ et al.

    A prospective study of work perceptions and psychosocial factors affecting the report of back injury

    Spine

    (1991)
  • BurdorfA et al.

    An epidemiological study of low-back pain in crane operators

    Ergonomics

    (1990)
  • BurtonAK et al.

    Prediction of the clinical course of low-back trouble using multivariable models

    Spine

    (1991)
  • BurtonAK et al.

    Prediction of low-back trouble frequency in a working population

    Spine

    (1989)
  • CadyLS et al.

    Strength and fitness and subsequent back injury in firefighters

    Journal of Occupational Medicine

    (1979)
  • Cats-BarilWL et al.

    Identifying patients at risk of becoming disabled because of low-back pain: the Vermont rehabilitation engineering center predictive model

    Spine

    (1991)
  • ChaffinDB et al.

    A longitudinal study of low-back pain as associated with occupational weight lifting factors

    American Industrial Hygiene Association Journal

    (1973)
  • CypressBK

    Characteristics of physician visits for back symptoms: a national perspective

    American Journal of Public Health

    (1983)
  • DamkotDK et al.

    The relationship between work history, work environment and low-back pain in men

    Spine

    (1984)
  • DehlinO et al.

    Back symptoms and psychological perception of work

    Scandinavian Journal of Rehabilitative Medicine

    (1977)
  • DeyoRA et al.

    Lifestyle and low-back pain. The influence of smoking and obesity

    Spine

    (1989)
  • DeyoRA et al.

    Descriptive epidemiology of low-back pain and its related medical care in the United States

    Spine

    (1987)
  • DillaneJB et al.

    Acute back syndrome—a study from general practice

    British Medical Journal

    (1966)
  • FrymoyerJW et al.

    Epidemiologic studies of low back pain

    Spine

    (1980)
  • FrymoyerJW et al.

    Risk factors in low back pain. An epidemiological survey

    Journal of Bone and Joint Surgery

    (1983)
  • GallagherRM et al.

    Determinants of return-to-work among low back pain patients

    Pain

    (1969)
  • GoertzMN

    Prognostic indicators for acute low-back pain

    Spine

    (1990)
  • GrazierK et al.
  • GruberGJ

    Relationships between whole-body vibration and morbidity patterns among interstate truck drivers

    US Department of Health Education and Welfare, DHEW (NIOSH) Publication

    (1974)
  • GruberGJ et al.

    Relationship between whole-body vibration and morbidity patterns among motor coach operators

    US Department of Health Education and Welfare, DHEW (NIOSH) Publication

    (1976)
  • GyntelbergF

    One-year incidence of lowback pain among male residents of Copenhagen aged 40–59

    Danish Medical Bulletin

    (1974)
  • HadlerN

    Disabling backache in France, Switzerland, and the Netherlands: contrasting sociopolitical constraints on clinical judgement

    Journal of Occupational Medicine

    (1989)
  • HasueM et al.

    Epidemiologic and clinical studies of long-term prognosis of low back pain and sciatica

    Spine

    (1980)
  • HazardRG et al.

    Disability exaggeration as a predictor of functional restoration outcomes for patients with chronic low-back pain

    Spine

    (1991)
  • HeliovaaraM et al.

    Determinants of sciatica and low-back pain

    Spine

    (1991)
  • HirschC et al.

    Low-back symptoms in a Swedish female population

    Clinical Orthopaedics and Related Research

    (1969)
  • HoralJ

    The clinical appearance of low back pain disorders in the city of Gothenberg, Sweden

    Acta Orthopaedica Scandinavica

    (1969)
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