Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Low Back Pain On Planet Earth

A global review of the prevalence of low back pain in the adult population.

Low back pain is a global health problem with huge personal and societal economic implications. It has been over ten years since the last global review of the prevalence of low back pain in the adult population. A recent study published in this month’s “Arthritis and Rheumatism” concludes that things have not gotten any better, with the burden of this condition being borne by females and individuals over age 40.

The mean prevalence of activity-limiting low back pain lasting more than one day was estimated by the authors to be approximately 12%; the one-month prevalence was estimated to be approximately 23%. Further, they found a higher prevalence of low back pain among females. Possible reasons for this finding include pain related to:

• Osteoporosis.

• Menstruation.

Pregnancy.

• Cultural influences causing sex differences in the likelihood of reporting pain.

• Sex-related differences in physical development during adolescence.

And in fact the prevalence of pain was significant during adolescence, with low back pain increasing with progression of adolescence, generally peaking earlier in girls. Nevertheless, the prevalence of low back pain was found to be highest during middle age—for most, the period of highest worker productivity. The negative impact to the private sector, the public sector and family life is obvious.

There does appear to be a decrease in the prevalence of less severe low back pain with aging, but this does not mean the anatomic cause of pain is necessarily getting better—whether the result of the healing of Time, or the intervention of the health care system. Many conditions beset the aged which could explain the apparent decrease in pain:

Cognitive impairment.

Depression.

• Decreased pain perception as the result of an aging nervous system.

• Increased tolerance to pain.

• Institutionalization (many studies do not include those in nursing homes, where the elderly might reside precisely because they experience so much pain).

Interestingly, low back pain was less prevalent in countries with developing economies, perhaps related to higher levels of physical activity, shorter height, higher pain thresholds, less obesity, and less access to health insurance that would allow for a better capture of the data related to back pain. Likewise, researchers may have less access to remote villages.

The mean lifetime prevalence of global low back pain was almost 39%, with particularly low rates from China, Nepal, Cuba, and Pakistan. Tibetans had a low rate of one-year pain prevalence. One can expect, however, the number of individuals suffering low back pain to increase as the planet ages.

The next step in research needs to include a cataloguing of risk factors for low back pain, and a determination of the best and most culturally-acceptable approach to easing that pain.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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