In the Journals

More than 1 in 10 worldwide suffer lower back pain

Lower back pain impacts an estimated 540 million people across the globe, and most are treated in a manner that is not consistent with best practice treatment guidelines, according to the editors of a series of papers in The Lancet.

“Low back pain is a major problem throughout the world and it is getting worse — largely because of the aging and increasing world population,” Stephanie Clark and Richard Horton, members of The Lancet editorial staff wrote.

The series provided details on the worldwide prevalence of back pain , options for prevention and treatment, and a call to action to address these concerns.

Problem’s scope

Jan Hartvigsen, PhD, of the department of health professions at Macquarie University in Sydney, was part of the Low Back Pain Work Group that discussed the prevalence of the condition. Their findings suggest that very few population groups, if any, are completely immune to the lower back pain, writing that it is an “extremely common symptom” that affects all age groups making it the most common disability worldwide.

Lower back pain affects 540 million people -- or more than 1 in 10 people -- worldwide, according to a report just published in The Lancet.
Source: Shutterstock

Other observations Hartvigsen and colleagues made include:

  • The global burden of lower back pain will likely increase during the next few decades, especially in low- and middle-income countries.
  • Work disability and health care costs that were ascribed to lower back pain differed significantly worldwide.
  • Low levels of physical activity, obesity and smoking were linked to lower back pain.
  • Most people with the condition could not correctly pinpoint the exact nociceptive source of their pain.
  • Lower back pain was a “complex condition” that has biophysical factors, comorbidities, pain-processing mechanisms, as well as psychological and social factors to the pain and related disability.
  • Most episodes of lower back pain did not last long and do not leave a lasting impact; however, periodic episodes are common and low back pain is “increasingly understood” as a long-lasting condition with a “variable course” as opposed to isolated events.
  • Disability from low back pain happened most frequently in working age groups.
  • Lower back pain was the reason for 60.1 million disability-adjusted life-years in 2015, an increase of 54% since 1990, with the largest increases occurring in low- and middle-income countries.

“Although there are several global initiatives to address the global burden of low back pain as a public health problem, there is a need to identify cost-effective and context-specific strategies for managing low back pain to mitigate the consequences of the current and projected future burden,” Hartvigsen and colleagues concluded.

Prevention and treatment

There have been many different resources and treatments suggested to combat lower back pain, according to Nadine E Foster, PhD, Arthritis Research UK Primary Care Centre, and members of the Low Back Pain Work Group, but a complete picture of this condition that could make approaches more universal is lacking.

The second paper in The Lancet series encapsulated the evidence of interventions for preventing and treating low back pain, recommendations from best practice guidelines such as those recommended by the American College of Physicians, and called out “effective, promising, or emerging solutions” and offered ways to make them better.

This group of researchers found:

  • Studies that examined back pain prevention were scarce; exercise alone or in tandem with education were the “only known effective interventions” for secondary prevention of lower back pain.
  • Evidence for prevention and treatment of lower back pain came primarily from adults in high-income countries; whether the resulting recommendations can be implemented in children or patients in low and middle-income countries is not known.
  • Guidelines recommended physical and psychological therapies, self-management, and some types of complementary medicine, and also de-emphasized pharmacological and surgical treatments; regular utilization of imaging and investigations was not recommended.
  • Nonevidence-based practice occurred across all income categories; frequent problems are presentations to EDs (including 2.6 million emergency visits each year in the United States, with “high rates of opioid prescription”) and “liberal use” of imaging, opioids, spinal injections, and surgery.
  • Solutions that showed potential include payment systems and legislation changes, combined health and occupational care, “exclusive implementation” of best practices, new plans for clinical pathways, and public health and prevention strategies.
  • Evidence supporting these solutions was lacking and whether they are appropriate for widespread use is not known.
  • Additional testing of these solutions, and development of new ones was needed, especially in low- and middle-income countries.

“Focusing on key principles, such as the need to reduce unnecessary health care for low back pain, support people to be active and stay at work, and reform unhelpful patient clinical pathways and reimbursement models, could guide next steps,” Foster and colleagues wrote. “No single solution will be effective, and a collective, global effort will take time, determination, and organization.”

“Without the collaborative efforts of people with low back pain, policy makers, clinicians, and researchers necessary to develop and implement effective solutions, disability rates, and expenditure for low back pain will continue to rise,” they added.

Call to action

Highlighting the strengths and addressing the deficiencies that Harvitsgen, Foster, and their respective research teams found to multiple stakeholders is a must to bring the burden of lower back pain under control, wrote Rachelle Buchbinder, MBBS, MSc, PhD, FRACP, FAHMS of the department of clinical epidemiology, Cabrini Institute and Monash University, Melbourne, Australia, and colleagues.

This group found that this process entails:

  • Calling on national and international funding agencies to make lower back pain research a “global health priority.”
  • Calling on other medical, political, medical and social policy leaders to sufficiently fund public health strategies dedicated to keeping lower back pain from hindering life across all populations.
  • Calling on WHO to put disabling lower back pain on the worldwide target list and draw more attention to its burden.

The medical community must also step up its efforts to treat lower back pain, according to researchers.

“Improved training and support of primary care doctors and other professionals engaged in activity and lifestyle facilitation, such as physiotherapists, chiropractors, nurses, and community workers, could minimize the use of unnecessary medical care,” Buchbinder and colleagues wrote.

“Crucial to changing behavior and improving delivery of effective care are system changes that integrate and support health professionals from diverse disciplines and care settings to provide patients with consistent messages about mechanisms, causes, prognosis and natural history of low back pain, as well as the benefits of physical activity and exercise,” they added.

Such strategies, Buchbinder and colleagues stated, could lower suffering and disability, as well as enhance the efficiency and efficacy for patients with lower back pain worldwide. – by Janel Miller

References:

Buchbinder R, et al. Lancet. 2018;doi.org/10.1016/S0140-6736(18)30488-4.

Clark S, Horton R. Lancet. 2018;doi:10.106.S0140-6736(18)30725-6.

Foster NE, et al. Lancet. 2018;doi.org/10.1016/S0140-6736(18)30489-6.

Hartwigsen J, et al. Lancet. 2018;doi:http://dx.doi.org/10.1016/S0140-6736(18)30480-X.

Disclosure: Please see the individual studies for the authors’ relevant financial disclosures.

Lower back pain impacts an estimated 540 million people across the globe, and most are treated in a manner that is not consistent with best practice treatment guidelines, according to the editors of a series of papers in The Lancet.

“Low back pain is a major problem throughout the world and it is getting worse — largely because of the aging and increasing world population,” Stephanie Clark and Richard Horton, members of The Lancet editorial staff wrote.

The series provided details on the worldwide prevalence of back pain , options for prevention and treatment, and a call to action to address these concerns.

Problem’s scope

Jan Hartvigsen, PhD, of the department of health professions at Macquarie University in Sydney, was part of the Low Back Pain Work Group that discussed the prevalence of the condition. Their findings suggest that very few population groups, if any, are completely immune to the lower back pain, writing that it is an “extremely common symptom” that affects all age groups making it the most common disability worldwide.

Lower back pain affects 540 million people -- or more than 1 in 10 people -- worldwide, according to a report just published in The Lancet.
Source: Shutterstock

Other observations Hartvigsen and colleagues made include:

  • The global burden of lower back pain will likely increase during the next few decades, especially in low- and middle-income countries.
  • Work disability and health care costs that were ascribed to lower back pain differed significantly worldwide.
  • Low levels of physical activity, obesity and smoking were linked to lower back pain.
  • Most people with the condition could not correctly pinpoint the exact nociceptive source of their pain.
  • Lower back pain was a “complex condition” that has biophysical factors, comorbidities, pain-processing mechanisms, as well as psychological and social factors to the pain and related disability.
  • Most episodes of lower back pain did not last long and do not leave a lasting impact; however, periodic episodes are common and low back pain is “increasingly understood” as a long-lasting condition with a “variable course” as opposed to isolated events.
  • Disability from low back pain happened most frequently in working age groups.
  • Lower back pain was the reason for 60.1 million disability-adjusted life-years in 2015, an increase of 54% since 1990, with the largest increases occurring in low- and middle-income countries.

“Although there are several global initiatives to address the global burden of low back pain as a public health problem, there is a need to identify cost-effective and context-specific strategies for managing low back pain to mitigate the consequences of the current and projected future burden,” Hartvigsen and colleagues concluded.

PAGE BREAK

Prevention and treatment

There have been many different resources and treatments suggested to combat lower back pain, according to Nadine E Foster, PhD, Arthritis Research UK Primary Care Centre, and members of the Low Back Pain Work Group, but a complete picture of this condition that could make approaches more universal is lacking.

The second paper in The Lancet series encapsulated the evidence of interventions for preventing and treating low back pain, recommendations from best practice guidelines such as those recommended by the American College of Physicians, and called out “effective, promising, or emerging solutions” and offered ways to make them better.

This group of researchers found:

  • Studies that examined back pain prevention were scarce; exercise alone or in tandem with education were the “only known effective interventions” for secondary prevention of lower back pain.
  • Evidence for prevention and treatment of lower back pain came primarily from adults in high-income countries; whether the resulting recommendations can be implemented in children or patients in low and middle-income countries is not known.
  • Guidelines recommended physical and psychological therapies, self-management, and some types of complementary medicine, and also de-emphasized pharmacological and surgical treatments; regular utilization of imaging and investigations was not recommended.
  • Nonevidence-based practice occurred across all income categories; frequent problems are presentations to EDs (including 2.6 million emergency visits each year in the United States, with “high rates of opioid prescription”) and “liberal use” of imaging, opioids, spinal injections, and surgery.
  • Solutions that showed potential include payment systems and legislation changes, combined health and occupational care, “exclusive implementation” of best practices, new plans for clinical pathways, and public health and prevention strategies.
  • Evidence supporting these solutions was lacking and whether they are appropriate for widespread use is not known.
  • Additional testing of these solutions, and development of new ones was needed, especially in low- and middle-income countries.

“Focusing on key principles, such as the need to reduce unnecessary health care for low back pain, support people to be active and stay at work, and reform unhelpful patient clinical pathways and reimbursement models, could guide next steps,” Foster and colleagues wrote. “No single solution will be effective, and a collective, global effort will take time, determination, and organization.”

“Without the collaborative efforts of people with low back pain, policy makers, clinicians, and researchers necessary to develop and implement effective solutions, disability rates, and expenditure for low back pain will continue to rise,” they added.

PAGE BREAK

Call to action

Highlighting the strengths and addressing the deficiencies that Harvitsgen, Foster, and their respective research teams found to multiple stakeholders is a must to bring the burden of lower back pain under control, wrote Rachelle Buchbinder, MBBS, MSc, PhD, FRACP, FAHMS of the department of clinical epidemiology, Cabrini Institute and Monash University, Melbourne, Australia, and colleagues.

This group found that this process entails:

  • Calling on national and international funding agencies to make lower back pain research a “global health priority.”
  • Calling on other medical, political, medical and social policy leaders to sufficiently fund public health strategies dedicated to keeping lower back pain from hindering life across all populations.
  • Calling on WHO to put disabling lower back pain on the worldwide target list and draw more attention to its burden.

The medical community must also step up its efforts to treat lower back pain, according to researchers.

“Improved training and support of primary care doctors and other professionals engaged in activity and lifestyle facilitation, such as physiotherapists, chiropractors, nurses, and community workers, could minimize the use of unnecessary medical care,” Buchbinder and colleagues wrote.

“Crucial to changing behavior and improving delivery of effective care are system changes that integrate and support health professionals from diverse disciplines and care settings to provide patients with consistent messages about mechanisms, causes, prognosis and natural history of low back pain, as well as the benefits of physical activity and exercise,” they added.

Such strategies, Buchbinder and colleagues stated, could lower suffering and disability, as well as enhance the efficiency and efficacy for patients with lower back pain worldwide. – by Janel Miller

References:

Buchbinder R, et al. Lancet. 2018;doi.org/10.1016/S0140-6736(18)30488-4.

Clark S, Horton R. Lancet. 2018;doi:10.106.S0140-6736(18)30725-6.

Foster NE, et al. Lancet. 2018;doi.org/10.1016/S0140-6736(18)30489-6.

Hartwigsen J, et al. Lancet. 2018;doi:http://dx.doi.org/10.1016/S0140-6736(18)30480-X.

Disclosure: Please see the individual studies for the authors’ relevant financial disclosures.