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  • Chronic LBP Correlated With 'Clustering' of Socioeconomic, Behavioral Factors

    While the disability and health care utilization burdens of chronic low back pain (cLBP) have been well-documented for some time, a new study finds that those burdens may fall unevenly, with poorer, less-educated, and less-healthy Americans most likely to experience the condition.

    Researchers analyzed demographic and health-related data from 5,103 Americans aged 20 to 69 years who participated in the National Health and Nutrition Examination Survey (NHANES) back pain questionnaire in the 2009-2010 survey cycle. Of those, 700 reported experiencing cLBP, which researchers defined as "current pain in the area between the lower posterior margin of the ribcage and the horizontal gluteal fold at the time of the survey, with a history of pain lasting almost every day for 3 months."

    Authors of the study then cross-referenced individuals reporting cLBP with different demographic, health, and health care usage data to get a better picture of how factors like income and education correlate with the condition. The results, e-published ahead of print in Arthritis Care & Research (abstract only available for free), show what authors call a "clustering of behavioral, psychosocial, and medical issues." Among them:

    • Overall prevalence of cLPB was 13.1%, with adults between 50 and 69 years old 2 times more likely to experience the condition. Women were more likely to have cLPB, and Caucasian participants were 1.5 times more likely to report cLBP than African American or Hispanic respondents.
    • Adults with cLBP had generally received less education than those without cLBP—they were nearly 2 times less likely to have a college degree, and 2.2 times less likely to have a high school diploma or associate's degree.
    • The odds of unemployment were 1.79 times higher for the cLBP group. The cLBP group was also 2.2 times more likely to have an annual income of $20,000 or less.
    • The rate of income from disability was 12.8% in the cLPB group, compared with 4.6% among those without cLBP.
    • More than 1 in 3 adults with cLBP screened positive for depression; the rate was just over 1 in 5 among those without cLBP.
    • Adults with cLBP were 3.9 times more likely to have reported sleep disturbances than those without cLBP.
    • Nearly half (48%) of the cLBP group reported 3 or more comorbidities, compared with 17% of individuals without cLBP.

    In terms of health insurance and utilization, adults with cLBP were less likely to be covered by private insurance, and more likely to have Medicare (2.25 times) or Medicaid (3.23 times). They were also 1.9 times more likely to report an overnight hospitalization in the past year. When researchers analyzed health and demographic data among the adults with cLBP who reported 10 or more health care visits per year, they found increased likelihoods linked to unemployment, disability income, depression, and sleep disturbances.

    Authors cite several limitations to their study—including an absence of data on institutionalized adults and adults over 69 years of age—but argue that the nature of the NHANES survey makes their findings freer from bias than claims-based studies, and more likely to be accurate given NHANES' use of trained interviewers to administer the questionnaire.

    While authors also acknowledge that their findings don't establish causal links between various factors and cLBP, they assert that "the clustering of behavioral, psychosocial, and medical issues should be considered in the care and rehabilitation of Americans with cLBP."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    • I have also noticed in my practice that the chronic pain is present in patients that suffer from great emotional pain. like loss of loved one , sexual or verbal abuse. Also it has become a way of income for many. We encourage people to be disabled, versus working with them with the underlying psychological problems. Not by giving them more drugs , but counseling. We need to works with establish vocational rehab that retrains them , work to get them off the couch. I find it hard to watch someone on disability for low back pain, but they are able to sit on and engage in activities on the internet all day. Over medication and addiction as a result is another reason for Chronic pain. Years ago there was no pain management clinics and the disability due to back pain was so much less. Addiction to pain killers is a large contributor.

      Posted by Annare L. Loubser PT, DPT, OCS, CFMT on 3/24/2016 9:27 AM

    • The timeframe is prophetic. In it we have had some of the highest unemployment rates in history, coupled with possibly the highest rates of illegal immigration. Who do illegal immigrants take jobs from? Executives at small to large businesses? No, the lower middle class who have been effectively disenfranchised. And what else has happened in this timeframe? The highest recorded claims for SS disability. In addition our immigration system released or declined to prosecute thousands of known illegals, setting them free across the nation, using the excuse of the government shutdown. Flooding the unskilled job market with even more people to compete for low-paying jobs to whom employers pay in cash to avoid the Social Security tax on wages.

      Posted by Sean on 3/25/2016 2:48 AM

    • I would also argue that there are quite a lot of people who suffer from cLBP but do not let it weigh them down because they are gainfully employed. They have an incentive to take control of their lives. I wonder what the outcome would be if those patients on the other end of the spectrum are offered good enough jobs instead if physical therapy visits. Of course those that are chronically lazy may decide to maintain the status quo of remaining on welfare.

      Posted by Muideen on 4/11/2016 7:40 AM

    • Chronic LBP is a symptom of a multifactoral problem, which is evidently clear to see through this well written review of the research. I am far from a "know it all", and I respect the opinions of my fellow comment writers above. However I must say, there is no existing evidence to back up or correlate cLBP to illegal immigration. For that reason, I encourage fellow commenters to be careful with drawing conclusions on publicly accessible forums such as this. People read these articles and comments to enhance there knowledge with the trust that they are getting the epidemy of current, unbiased, and evidenced based information. Please try to lead the community of our profession in an evidence/clinical experience based model/compass when trying to understand trends and assessing data. As an aspiring PT researcher myself, I'm very curious to hear from the authors, how do you plan to continue the research on this particular topic? And have Height, Weight, BMI, and Activity Level been considered for variables within this population(in regard to correlation with Behavior, Socioeconomics, and psychosocial variables) moving forward? Emotional factors do seems to have a correlational relationship on pain preception/severity. Perhaps future research should look to answer the question, "what came first, the pain or the depression/stress/anxiety/death of a loved one/ect. ?" If research continues to support this type of correlation and even finds causation, perhaps future therapy for such symptoms could be co-treated by PT and Psychosocial medicine/therapy to provide the greatest assistance to affected patients. *(Food for thought)* All in all, this as a great research review, thank you APTA for making this review accessible to all of interest. PT could be an integral team member in reducing opioid abuse and cLBP management, hope we all can make that happen. Please keep us updated on future evidence based findings.

      Posted by Jason Lydell SPT on 1/28/2017 10:11 PM

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