What Low Back Pain Is and Why We Need to Pay Attention
SOURCE: Lancet. 2018 (Mar 20) [Epub]
Prof Jan Hartvigsen, PhD, Mark J Hancock, PhD, Alice Kongsted, PhD, Prof Quinette Louw, PhD, Manuela L Ferreira, PhD, Stéphane Genevay, MD, Damian Hoy, PhD, Prof Jaro Karppinen, PhD, Glenn Pransky, MD, Prof Joachim Sieper, MD, Prof Rob J Smeets, PhD, Prof Martin Underwood, MD
Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Odense, Denmark;
Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.
Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide.
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For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause – eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling.
Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect.
Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.
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Introduction
Low back pain is an extremely common symptom experienced by people of all ages. [1–3] In 2015, the global point prevalence of activity-limiting low back pain was 7.3%, implying that 540 million people were affected at any one time. Low back pain is now the number one cause of disability globally. [4] The largest increases in disability caused by low back pain in the past few decades have occurred in low-income and middle-income countries, including in Asia, Africa, and the Middle East, [5] where health and social systems are poorly equipped to deal with this growing burden in addition to other priorities such as infectious diseases.
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Rarely can a specific cause of low back pain be identified; thus, most low back pain is termed non-specific. Low back pain is characterised by a range of biophysical, psychological, and social dimensions that impair function, societal participation, and personal financial prosperity. The financial impact of low back pain is cross-sectoral because it increases costs in both health-care and social supports systems. [6] Disability attributed to low back pain varies substantially among countries, and is influenced by social norms, local health-care approaches, and legislation. [7] In low-income and middle-income countries, formal and informal social-support systems are negatively affected. While in high-income countries, the concern is that the prevalent health-care approaches for low back pain contribute to the overall burden and cost rather than reducing it. [8] Spreading high-cost health-care models to low-income and middle-income countries will compound rather than alleviate the burden. Low back pain is therefore an urgent global public health concern.
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