04. Facts and Figures of Back Pain

This episode presents the different groups within low back pain and looks at where statistics come from. This information helps you battle fear associated with the condition and validate your experience of pain.

Facts about Low Back Pain (LBP)

LBP is defined as pain and discomfort below the costal margin and above the inferior gluteal folds, with or without referred leg pain.1

LBP is categorized into acute LBP and chronic LBP, which is LBP lasting for longer than 12 weeks.2,3,4,5,6

LBP is the most common form of chronic pain,7 a leading cause of disability in people younger than 45 years old8 and has a lifetime prevalence of 70 % in industrialised countries9.

LBP is among the top ten causes of long-term disability in every country and number one cause in 86 countries.10 LBP is the fifth most common reason for all doctor's visits in the United States11 and the third most common diagnosis in German prevention and rehabilitation facilities.12

One year after a first episode of back pain 62% of people will still experience pain while 16% of those initially unable to work are still not working.13

What Back Pain do You Have?

• 80-95 % non-specific LBP
• 5% radicular syndrome
• 1 % serious spinal pathology

What is Non-Specific LBP?

Today it is widely accepted that the biggest group of LBP is non-specific-LBP. Non-specific LBP means that no anatomic structure can be identified that is at fault. You might be surprised to learn that this is the case with 80-95% of all people with

LBP. 9,12,4,5,14,15

How Should it be Diagnosed?

Almost all guidelines16,17,6 recommend that people presenting with an acute episode of LBP should be screened for:

1. potential serious pathology (e.g. cancer, fractures, infections of the spine, cauda equina syndrome, systemic disease) that could cause pain in the back
2. radicular syndrome (that means pain arises from the nerve roots in your spine)

Potential serious pathologies for LBP are very rare (0,01% spinal infections, 0,7% cancer) and together with neurological impairment make up for approximately 1-5% of all LPB-Incidents.18

Nerve root pain (pain caused by the nerves in your spine) is considered to be present if there is pain radiating down the leg, together with a positive neurological examination (muscle strength, sensibility and deep tendon reflexes should be assessed). The neurological examination is positive when there is a palsy/weakness of a muscle in your leg that wasn´t there before, or if you experience incontinence or urinary retention that wasn´t there previous to your back pain, or if parts of your skin are numb.

If you have no confirmed serious disease and no radicular symptoms you have non-specific LBP.

For LBP with substantial neurologic involvement (1-5 %), guidelines generally do not recommend conducting any further assessment until appropriate conservative management (which is rarely defined) has failed, after which MRI or CT (imaging of your spine) is generally recommended.6

Find out more: www.mybackrecovery.com

Sources:

1. Duthey BB, Ph D. Priority Medicines for Europe and the World " A Public Health Approach to Innovation " Update on 2004 Background Paper Background Paper 6 . 24 Low back pain. (March 2013).
2. Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2(November 2004):192-300. doi:10.1007/s00586-006-1072-1.
3. Savigny P Watson P, Underwood M, Ritchie G , Cotterell M, Hill D, Browne N, Buchanan E, Coffey P, Dixon P, Drummond C, Flanagan M, Greenough,C, Griffiths M, Halliday-Bell J, Hettinga D, Vogel S, Walsh D. KS. Low Back Pain: early management of persistent non-specific low back pain. London Natl Collab Cent Prim Care R Coll Gen Pract. 2009;(May):1-235.
4. Goertz M, Thorson D, Bonsell J, et al. Adult Acute and Subacute Low Back Pain. 15th ed.; 2012.
5. Acute A, Pain M, Group G. Evidence-Based Management of Acute Musculoskeletal Pain. Pain. 2003;370(9599):63-82. doi:10.1016/S0140-6736(07)61670-5.
6. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J. 2010;10(6):514-529. doi:10.1016/j.spinee.2010.03.032.
7. Froud R, Patterson S, Eldridge S, et al. A systematic review and meta-synthesis of the impact of low back pain on people's lives. BMC Musculoskelet Disord. 2014;15:50. doi:10.1186/1471-2474-15-50.
8. Lis AM, Black KM, Korn H, Nordin M. Association between sitting and occupational LBP. Eur Spine J. 2007;16(2):283-298. doi:10.1007/s00586-006-0143-7.
9. Burton a K, Balagué F, Cardon G, et al. Chapter 2. European guidelines for prevention in low back pain : November 2004. Eur Spine J. 2006;15 Suppl 2(2006):S136-S168. doi:10.1007/s00586-006-1070-3.
10. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England). 2015;6736(15):1990-2013. doi:10.1016/S0140-6736(15)60692-4.
11. Cowan P. Consumer Guidelines for Low Back Pain. (Kelly N, Chou R, eds.).; 2008. http://theacpa.org/condition/back-pain.
12. Raspe H. Gesundheitsberichterstattung Des Bundes - Rückenschmerzen. Heft 53. Berlin: Robert Koch-Institut; 2012.
13. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149-165. doi:10.1007/s00586-002-0508-5.
14. Bernhard A, Bundesärztekammer, eds. Nationale VersorgungsLeitlinie Kreuzschmerz. Langfassun. Berlin: Ärztliches Zentrum für Qualität in der Medizin; 2015. doi:10.6101/AZQ/000250.
15. van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15 Suppl 2:S169-S191. doi:10.1007/s00586-006-1071-2.
16. Pillastrini P, Gardenghi I, Bonetti F, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Jt Bone Spine. 2012;79(2):176-185. doi:10.1016/j.jbspin.2011.03.019.
17. Koes BW, van Tulder M, Lin C-WC, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075-2094. doi:10.1007/s00586-010-1502-y.
18. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med. 2002;137(7):586-597. doi:10.7326/0003-4819-137-7-200210010-00010.