2023-05-23 00:30:00
The back began to complain a long time ago: the lament is heard, according to some scientists, since the beginning of industrialization, which made the leap towards modern life. But it also gave away changes in lifestyle, such as a decrease in physical activity, poor posture and the use of furniture, a cocktail that favored a wedge in the lower back bones and with it, pain. Low back pain is one of the most frequent pains that come to the doctor’s office and its evolution is on the rise: a study published in the journal The Lancet Rheumatology On the prevalence of this pathology, he estimates that more than 600 million people suffered from it in the world in 2020 and estimates that in 30 years there will be more than 800 million affected. The authors point to smoking, poor posture at work, and obesity as key risk factors for this disease, which is already —and aims to continue being— the leading cause of disability.
Low back pain (also called low back pain or lumbago) is that more or less intense discomfort in the lower back, “between the twelfth ribs and the gluteal folds and that lasts a day or more,” define the study authors. . Marcos Paulino, president-elect of the Spanish Society of Rheumatology, who did not participate in the study, welcomes the crystallization, with data in a scientific journal, of what they are used to seeing in the consultation: “It is an epidemic, something very frequent . And it is a pathology that is difficult to prevent because, even if you recommend physical exercise, having a good weight and avoiding bad postures, there are 60% of low back pain that have no explanation. Only 40% are preventable.”
The doctor, who is also head of the Rheumatology service at the General University Hospital of Ciudad Real, assures that the lower back is “the Achilles heel of the human being, a very sensitive area that suffers more frequently.” “80% of the population will have low back pain at some point in their lives. The good thing about this study is that it quantifies it and can make it transcend the magnitude of the problem, ”he reflects.
In the systematic review published this Tuesday in The Lancet Rheumatology, the authors used information from the 2021 Global Burden of Disease (GBD) Study—a large, worldwide observational epidemiological investigation of a variety of pathologies—to estimate the prevalence of low back pain between 1990 and 2020 in more from 200 countries. The data showed that low back pain affected 619 million people on the planet in 2020 and in 2050, there will be about 843 million. The highest prevalence standardized by years was found in Central Europe, specifically, in the Czech Republic and Hungary; the lowest prevalence was recorded in the Maldives and Myanmar.
This increase in the coming years is due, according to Garland Culbreth, a researcher at the Institute for Health Metrics and Evaluation at the University of Washington and author of the study, “to trends in population growth and aging.” “Population growth means more people, and population aging means more people in the most prevalent age groups, hence an increase in low back pain cases,” she notes.
Since this condition was already, according to the authors, the first cause of disability, the researchers also measured the years lived with disability (YLD, for its acronym in English). This indicator reflects the impact of the disease—in this case, low back pain—on quality of life and calculates that a YLD is one full year of healthy life lost due to disability or poor health. In 2020, the authors note, there were 69 million years lived with disability due to low back pain, “and although there was a slight decrease since 1990 in the percentage of YLD from all causes worldwide, low back pain was still the main contributor. to the YLD worldwide”, they point out.
Scientists have verified that the global prevalence is higher in women than in men in all age groups, although the years weigh on the pathology: the prevalence of low back pain and the years lived with disability increase with age, the group being from 80 to 84 years the group with the highest rate. In fact, a fifth part of older adults with low back pain report difficulties caring for themselves at home or participating in social and family activities.
Smoking, obesity and work
The authors point to smoking, obesity and ergonomics at work as the main risk factors, although not the only ones, that spur low back pain. The risk of low back pain attributed to tobacco use was highest among middle-aged men and lowest among women ages 15-49, while the influence of work postures was strongest among young adult males (aged 15 years). to 49 years) and less in women over 70 years. The risk of low back pain from having a high body mass index was highest in women aged 50 to 69.
Manuela Ferreira, a member of the Sydney Muscoskeletal Health group at the University of Sydney and author of the study, explains how tobacco works: “Smoking has been associated with impaired circulation to spinal structures, for example, the disc and joints. , as well as with the weakening of the bones. But we also know that smoking is often associated with other lifestyle factors, such as physical inactivity, obesity, lack of sleep, all of which have been linked to an increased risk of developing low back pain.” The researcher also notes that a high body mass index (BMI) “may be linked to other unhealthy lifestyle factors that may increase the risk of low back pain, but it is also possible that a high BMI increases the load on the structures of the lower back.” spine, predisposing them to injury. Regarding occupational factors, Ferreira justifies his role: “Occupational factors that can contribute to the risk of developing low back pain include lifting heavy objects, sitting or standing for a long time, bending and rotating the trunk repeatedly, as well as stress and fatigue.”
The high prevalence of this disease throughout the world, warn the researchers, “could have important social and economic consequences, especially considering the substantial cost of care for this condition.” And they give an example: from 2012 to 2014, the direct costs for all people with a spinal condition in the United States was 315,000 million dollars. Added to the economic weight of medical care for this pathology is the labor impact: its high prevalence in the active population causes absences from work and even premature retirement: “In the United States, 15.4% of the workforce labor force reports an average of 10.5 days of work lost per year due to chronic low back pain”, the study states as an example.
Ineffective drugs
The authors are wary of the potential effectiveness of some drugs, noting that “paradoxically, the use of treatments with little or no efficacy can delay recovery and potentially increase the risk of long-term back-related disability and, consequently, increase the burden of this disease globally. “Many treatments currently offered to manage low back pain have little, no, or unknown efficacy. These include simple pain relievers, such as acetaminophen, and strong ones, such as opioids, physical therapies (traction, ultrasound, transcutaneous electrical nerve stimulation), and many surgical procedures, such as surgical fusion. When these options are given to replace treatments that improve the symptoms of low back pain, such as exercise, psychological interventions and structured advice, they can delay recovery”, laments Ferreira.
In the spotlight are, above all, opioids against pain: in Australia, for example, this class of drugs is the most prescribed medicine for low back pain. Against the backdrop of the very serious opioid epidemic sweeping the United States, researchers recall that opioids “are responsible for significant adverse health events” and warn against their use. “This strategy is harmful not only because opioids are associated with serious adverse effects, including death from overdose, but the benefits of opioids in improving pain and function in patients with low back pain are at best , modest ”, ditch Ferreira.
Paulino admits that “time and resources” are needed to improve the response to this pathology. “To properly address the problem, to know the disease well, to exercise or to learn relaxation techniques to deal with pain, time is needed. And we live in such a fast-paced society that the patient wants something quick, a pill, because he has to work or return to his activities. The approach would be better if we had more time and resources, ”he reflects.
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