The incidence of back pain
Back pain, discomfort, sick leave and an economic burden.
Back pain is very common
In health questionnaire surveys musculoskeletal (MSC) pain is the complaint cited most frequently. There are a wide range of conditions and symptoms to which this term is applied. MSC is very common and has significant impact on individuals, and thence, society as a whole. Typically, around 50% of the population report MSC pain at one or more locations in their body for one week, at least in the month prior. Back pain is the most common site for pain in younger and middle aged adults, and knee pain in older people.
A recent EU Commission study (1) suggests that 67 million people suffered pain in their lower or upper back in the previous week (Question: "In the last week, have you had any pain affecting your muscles, joints, neck or back which has affected your ability to carry out the activities of daily living?").
The prevalence of physical disability rises with age; approximately 60% of women aged over 75 report some physical limitations. For the active working population, general MSC, and back pain in particular, is a common cause of sick leave and long- term time out of employment (2).
Low back pain is a major health and socio-economic problem throughout Europe. The lifetime prevalence has been estimated at anything between 59% to 90%(3). In any one year, the incidence of back pain is reported to be ~5% of the population (3).
The Bone and Joint Decade Report, (2005) states that, “Most episodes of low back pain settle after a couple of weeks but many have a recurrent course with further acute episodes affecting 20-44% of patients within one year in the working population and lifetime recurrences of up to 85%.”(4)
For more information, go here: www.boneandjointdecade.org
Back pain is a common problem at work
A third of EU workers consider themselves at risk from back pain and back ache in the work place. A number of industries such as agriculture and construction are perceived to carry higher risk:
Figure 1 Workers considering themselves at risk of backache
Such risk perceptions appear well founded in that incidence of back pain and back ache at work is high and is the most frequent problem:
- The last available EU-wide survey from ten years ago, found that the most common work-related health problem was back pain affecting 30% of workers (5).
- A more recent survey in Spain found that the most important work-related physical problems derive from maintaining the same posture and carrying out repetitive tasks. The outcome leads to lower back pain (40.9% of all workers), neck pain (40%) and upper back pain (22.9%)(6).
Back pain costs society
Back pain is the second leading cause of sick leave. In the UK, 12.5% of all sick days were found to be related to low back disorders. Figures for Sweden are similar with an estimated 13.5% of sick days said to be the result of lower back problems (Andersson, 1999(7)). The economic cost of back pain to society in the Netherlands has been estimated to be 1.7% of the gross national product (Van Tulder et al., 1995(8)).
Guidelines for prevention in low back pain
The European Commission Directorate for Research is funding work for development of guidelines for the management of low back pain.
Three Working Groups have been established:
- working group on European guidelines for acute low back pain,
- working group on European guidelines for chronic low back pain,
- working group on European guidelines for prevention of low back pain.
The work is funded under the so called COST programme, (European Cooperation in the field of Scientific and Technical Research).
Whilst the report concludes that prevention is difficult:
“Primary causative mechanisms remain largely undetermined: risk factor modification will not necessarily achieve prevention.”
There are things that can be done to limit impact:
“There is considerable scope, in principle, for prevention of the consequences of lower back pain – e.g. episodes (recurrence), care seeking, disability, and workloss.”
For more information go to www.backpaineurope.org
To access the guidelines from the working group three go to http://www.backpaineurope.org/web/files/WG3_Guidelines.pdf
Link to purchase useful article: How to prevent low back pain. Best Pract Res Clin Rheumatol. 2005 Aug;19(4):541-55. Review.
REFERENCES:
(2) European Commission website: “Europa - Public Health - Health information - Dissemination of information - Disease and conditions information sheets - Major and chronic diseases - Musculoeskeletal conditions.” http://ec.europa.eu/health/ph_information/dissemination/diseases/musculo_en.htm accessed 1 Feb 2008.
(3) Dr. Veerle Hermans, 2000, “Research on work-related low back disorders,” Institute for Occupational Safety and Health, Brussels
(4) The Bone and Joint Decade Report, 2005, European Action Towards Better Musculoskeletal Health, European League Against Rheumatism (EULAR), European Federation of National Associations of Orthopaedics and Traumatology (EFORT) & International Osteoporosis Foundation (IOF)
(5) European Foundation for the Improvement of Living and Working Conditions, 1996, survey of a representative sample of 1000 workers in each MemberState, or 15,800 persons in total.
(6) Fifth National Survey on Working Conditions (V Encuesta Nacional de Condiciones de Trabajo), October 2004, INSHT, the Spanish National Institute of Safety and Hygiene in the Workplace (Instituto Nacional de Seguridad e Higiene en el Trabajo)
(7) Andersson GBJ. Epidemiological features of chronic low-back pain. The Lancet 1999; 354: 581-585.
(8) Van Tulder MW, Koes BW, Bouter LM. A cost-illness study of back pain in the Netherlands. Pain 1995 ; 62 : 233-240.
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