The Rising Prevalence of Chronic Low Back Pain

The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC 27599-7590, USA.
Archives of internal medicine (Impact Factor: 17.33). 03/2009; 169(3):251-8. DOI: 10.1001/archinternmed.2008.543
Source: PubMed


National or state-level estimates on trends in the prevalence of chronic low back pain (LBP) are lacking. The objective of this study was to determine whether the prevalence of chronic LBP and the demographic, health-related, and health care-seeking characteristics of individuals with the condition have changed over the last 14 years.
A cross-sectional, telephone survey of a representative sample of North Carolina households was conducted in 1992 and repeated in 2006. A total of 4437 households were contacted in 1992 and 5357 households in 2006 to identify noninstitutionalized adults 21 years or older with chronic (>3 months), impairing LBP or neck pain that limits daily activities. These individuals were interviewed in more detail about their health and health care seeking.
The prevalence of chronic, impairing LBP rose significantly over the 14-year interval, from 3.9% (95% confidence interval [CI], 3.4%-4.4%) in 1992 to 10.2% (95% CI, 9.3%-11.0%) in 2006. Increases were seen for all adult age strata, in men and women, and in white and black races. Symptom severity and general health were similar for both years. The proportion of individuals who sought care from a health care provider in the past year increased from 73.1% (95% CI, 65.2%-79.8%) to 84.0% (95% CI, 80.8%-86.8%), while the mean number of visits to all health care providers were similar (19.5 [1992] vs 19.4 [2006]).
The prevalence of chronic, impairing LBP has risen significantly in North Carolina, with continuing high levels of disability and health care use. A substantial portion of the rise in LBP care costs over the past 2 decades may be related to this rising prevalence.

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Available from: Andrea S Wallace
    • "In terms of sex, earlier studies found that males have higher prevalence of LBD than females (Punnett et al., 2005). Recently; however, studies are reporting that females have a higher prevalence of LBD than males (Freburger et al., 2009). The rising prevalence of LBD in females may be partially attributed to the fact that more females are obtaining employment in physically demanding occupations than in the past. "
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    ABSTRACT: The objective of the present study was to determine if there is a sex-based difference in lifting technique across increasing-load conditions. Eleven male and 14 female participants (n = 25) with no previous history of low back disorder participated in the study. Participants completed freestyle, symmetric lifts of a box with handles from the floor to a table positioned at 50% of their height for five trials under three load conditions (10%, 20%, and 30% of their individual maximum isometric back strength). Joint kinematic data for the ankle, knee, hip, and lumbar and thoracic spine were collected using a two-camera Optotrak motion capture system. Joint angles were calculated using a three-dimensional Euler rotation sequence. Principal component analysis (PCA) and single component reconstruction were applied to assess differences in lifting technique across the entire waveforms. Thirty-two PCs were retained from the five joints and three axes in accordance with the 90% trace criterion. Repeated-measures ANOVA with a mixed design revealed no significant effect of sex for any of the PCs. This is contrary to previous research that used discrete points on the lifting curve to analyze sex-based differences, but agrees with more recent research using more complex analysis techniques. There was a significant effect of load on lifting technique for five PCs of the lower limb (PC1 of ankle flexion, knee flexion, and knee adduction, as well as PC2 and PC3 of hip flexion) (p < 0.005). However, there was no significant effect of load on the thoracic and lumbar spine. It was concluded that when load is standardized to individual back strength characteristics, males and females adopted a similar lifting technique. In addition, as load increased male and female participants changed their lifting technique in a similar manner.
    No preview · Article · May 2016 · Applied Ergonomics
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    • "Chronic low back pain (CLBP) is a highly prevalent condition (WHO, 1998; ONS, 2000; Waddell and Burton, 2000; Walker, 2000; NICE, 2009) representing an enormous economic cost worldwide (Van Tulder et al., 1995; Guo et al., 1999; Maniadakis and Gray, 2000; Ekman et al., 2005; Waddell et al., 2002; Stewart et al., 2003; Ricci et al., 2006; Katz, 2006; NICE, 2009; Freburger et al., 2009). CLBP is a multifactorial condition with a variety of associated symptoms (National Research Council, 1998; National Research Council & Institute of Medicine (2001)), abnormalities in the intervertebral discs being a common association, and also suspected as a potential source of pain in CLBP (Adams and Roughley, 2006; Adams et al., 2010). "
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    ABSTRACT: Indirect measurement of disc hydration can be obtained through measures of spinal height using stadiometry. However, specialised stadiometers for this are often custom-built and expensive. Generic wall-mounted stadiometers alternatively are common in clinics and laboratories. This study examined the reliability of a custom set-up utilising a wall-mounted stadiometer for measurement of spinal height using custom built wall mounted postural rods. Twelve participants with non-specific chronic low back pain (CLBP; females n = 5, males n = 7) underwent measurement of spinal height on three separate consecutive days at the same time of day where 10 measurements were taken at 20 s intervals. Comparisons were made using repeated measures analysis of variance for 'trial' and 'gender'. There were no significant effects by trial or interaction effects of trial x gender. Intra-individual absolute standard error of measurement (SEM) was calculated for spinal height using the first of the 10 measures, the average of 10 measures, the total shrinkage, and the rate of shrinkage across the 10 measures examined as the slope of the curve when a linear regression was fitted. SEMs were 3.1 mm, 2.8 mm, 2.6 mm and 0.212, respectively. Absence of significant differences between trials and the reported SEMs suggests this custom set-up for measuring spinal height changes is suitable use as an outcome measure in either research or clinical practice in participants with CLBP.
    Full-text · Article · Oct 2015 · Applied ergonomics
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    • "There are several reasons to better understand the relationship between LBP and radiographic findings of degeneration in the lumbar spine. First, the prevalence of chronic LBP is rising and is associated with decreased physical function [18]. Second, plain film radiographgy is commonly used in clinical practice because it is relatively inexpensive and easily administered [19] [20]. "
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    ABSTRACT: Background/purpose: Low back pain (LBP) is a prevalent musculoskeletal condition and represents a substantial socioeconomic burden. Plain film radiography is a commonly used imaging technique. Radiographic features (RFs) such as disc space narrowing, osteophytes, spondylosis, endplate sclerosis, spondylolisthesis, and facet joint osteoarthritis have all been debated as potential pain generators in the lumbar spine. The aim of this study is to (1) determine the association between LBP and lumbar spine RFs in both community- and occupation-based groups and (2) to determine if there are differences in these associations between these two groups. Methods: A systematic electronic search of PubMed, EMBASE, CINAHL, and Cochrane was conducted with keywords related to LBP and lumbar spine RFs. The search was restricted from inception of each respective database to April 2014. Inclusion criteria consisted of observational studies of adults (≥18 years) with and without nonspecific LBP. Studies were excluded if they investigated LBP related to infection, malignancy, or rheumatologic nature or were conducted in cadavers. Quality assessment was conducted with the Item Bank for Assessment of Risk of Bias and Precision for Observational Studies of Interventions or Exposures. Random effect models were used for all pooled analyses with associations represented by odds ratios (OR) and 95% confidence intervals (95% CIs). Statistical heterogeneity was assessed with I(2), with significant heterogeneity represented as >50%. Results: Overall, 28 (22 community-based and six occupation-based) studies met the eligibility criteria consisting of 26,107 subjects. A significant, positive association was found between disc space narrowing and LBP, which did not differ (p = 0.22) in both community- and occupation-based studies [OR = 1.47 (95% CI: 1.36-1.58)] and [OR = 1.76 (95% CI: 1.34-2.33)], respectively. No significant statistical heterogeneity was present in either estimate (I(2) = 0.0%). A significant association was found between spondylolisthesis and LBP in occupation-based studies [OR = 2.21 (95% CI: 1.44-3.39)] that differed significantly (p < 0.01) from community-based studies [OR = 1.12 (95% CI: 1.03-1.23)]. These individual estimates were also homogeneous (I(2) = 0.0%). The association between other radiographic features was modest (i.e., spondylosis and osteophytes) or non-significant (i.e., endplate sclerosis and facet joint). Quality of included studies varied, with the majority demonstrating good quality. Conclusion: A significant association was found between disc space narrowing in both community- and occupational-based populations without significant differences between the associations. A significant strong association was found between spondylolisthesis and LBP among the occupational group but was weakly associated in the community-based group, which supports that spondylolisthesis may contribute a specific cause for LBP.
    Full-text · Article · Dec 2014 · Seminars in Arthritis and Rheumatism
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