Back Care Info

Lower back pain affects most people . According to a recent survey published in 2000 nearly half the adult population of the U.K. (49%) report lower back pain lasting for at least 24 hours at some time during the year 
It is estimated that up to four out of five people (80%) will experience back pain lasting more than a day at some time during their life.

How long does it last

In 1998 in over half of those people who reported back pain the episode lasted for over 4 weeks - affecting 8 million  people and in the case of 2.5 million of these the back pain lasted throughout the year. 
Young people are more likely to have brief acute episodes of back pain while chronic pain is more characteristic of older people. There is little difference in the occurrence in men and women. 

What is the impact of back pain

Persistent back pain (ie pain which has lasted for more than three months or has been present on more than half the days of the previous year), in particular, has a serious impact on people’s lives. It frequently reduces people’s quality of life and adversely affects their family and social relationships.

The direct healthcare costs of back pain are huge, including £141m each year for GP consultations, £150.6m for NHS physiotherapy and £512m for hospital care (inpatient, outpatient and emergency). Overall, back pain costs the NHS and community care services more than £1 billion each year – and with £565 million also spent on private services, the direct annual healthcare costs are over £1.6 billion.2

10% of those complaining of back pain visited a complementary practitioner (osteopath, chiropractor, acupuncturist) .2 
Work related costs Reports have estimated that the total cost of back pain corresponds to between 1% and 2% of Gross National Product (GNP).5

Musculoskeletal disorders were the most commonly reported type of work-related illness in the latest survey of self-reported work-related illness (SWI 01/02). 520,000 suffered from a 
disorder mainly affecting their back. This means that on any one day, about 1% of the working-age 
population are on sickness absence due to a back problem.6
Nearly 5 million working days were lost through bad backs in 2003/04. On average each sufferer took about 20 days off in that period.6

Back pain is the nation's leading cause of disability, with 1.1 million people disabled by it.7
Back pain is the second commonest cause of long term sickness absence for much of the UK8 and the commonest for people in manual occupations.9

At any one time 430,000 people in the UK are receiving Social Security payments primarily for back pain.10 
One in eight (13%) unemployed people say that back pain is the reason they are not working.3 
HSE estimated that work-related musculoskeletal disorders cost employers between £590 million and £624 million per annum.11

HSE demonstrated that for every £1 spent in insured accident costs, up to a further £36 can be spent on uninsured costs.11

Risk factors for low back pain

Reported back pain is most common in those with skilled manual, partly skilled and unskilled jobs.3

Some occupations can cause back problems without involving injury. Among these are:

• driving a motor vehicle. People who drive over 25,000 miles a year averaged just over 22 days a year off work with a bad back, compared with just over 3 days for low mileage drivers.12 
• driving a train. Train drivers are twice as likely as HGV drivers to report low back pain.13 
• work involving intensive use of the telephone without headsets. 50% of office workers who use a telephone for at least two hours a day and also use a computer report neck pain and 31% lower back pain14
• being a supermarket cashier-57% experience lower back pain in a year. 15

Low back pain in children

Repeated studies over the past 10 years have indicated a significant incidence of recurrent back pain in school children, ranging from 13.1% in children 10-16 years increasing to adult levels of 21.6% by age 16.16 
Recurrent back pain may lead to disabling consequences. 23% of children with back pain visited a medical practitioner. Of this group 30% experienced a loss of physical activity/sports; 26% of these children had been absent from school because of LBP17. A study using magnetic resonance imaging (MRI) found degenerative disc changes were already present in some children by age 15 years. These children reported higher levels of back pain.18 
People who experience back pain as a child or teenager are more likely to experience back pain as an adult.19 

Treating low back pain

Currently recommended treatment20 for an acute attack of low back pain, which has no danger signs (known as 'Red Flags'), is

• painkillers continuing with normal activities 
• manipulation if required 
• remaining at work or returning as soon as possible

Bed rest is not recommended and makes matters worse and so should be avoided. Despite this the last survey in 1988 (2) showed that GPs still recommended bed rest to one in four of the people who consult them about back pain. 
The longer someone is off work with back pain, the lower their chances of returning to work.(50% will return at six months but only 5% after one year)10 Patients who return to normal activities feel healthier, take fewer pain killers, and are less distressed than those who limit their activities.

Psychological and social factors

('Yellow Flags') are more important risk factors for developing chronic pain than physical symptoms and signs.20 

Recent guidelines emphasise the need to monitor low back pain reports in the workplace.10

• stay at work if possible with any necessary modifications 
• maintain contact if not able to remain at work 
• the possibility of returning to work even if not entirely pain free 
• the importance of rehabilitation

References

1. Palmer K.T, Walsh K, Bendall H, Cooper C & Coggon D Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years B.M.J. 2000 320 1577-1578 
2. Maniadakis A., Gray A, The economic burden of back pain in the UK Pain 2000 84 95-103 
3. The Prevalence of Back Pain in Great Britain 1998 Department of Health 
4. Pain in Europe, A 2003 report. 
5. Norlund AI, Waddell G. Cost of back pain in some OECD countries. In Nachemson AL, Jonsson E, eds. Neck and back pain: the scientific evidence of causes, diagnosis and treatment. Philadelphia: Lippincott, Williams & Wilkins, 2000. 
6. Back Health at Work, HSE 2005 
7. Disability Data from the Labour Force Survey , Labour Market Trends June 1998 
8. DWP 2002 
9. Chartered Institute of Personnel & Development (CIPD) 2004
10. OH guidelines Carter JT, Birrell LN (Editors) 2000. Occupational health guidelines for the management of low back pain at work - principal recommendations. Faculty of Occupational Medicine, London 
11. The costs of accidents at work, HS(G)96 2nd Edition, HMSO 1997 
12. Porter J.M. Driving and Musculoskeletal Health The Safety and Health Practitioner Supplement July 1999
13. Helliwell P.S, Smeathers J.E. Driving posture,vibration and Psychosocial factors for back pain in long distance drivers Leeds University 1998
14. University of Surrey quoted in the Safety and Health Practitioner May 1999
15. Musculoskeletal disorders in Supermarket Cashiers Health and Safety Executive 1998
16. Jones M.A., Hitchen PJ, Stratton G (2001) Low back pain in children. Pediatric Exercise Science 316. 
17. Jones MA, Stratton G, Reilly T, Unnithan VB (2004) A school-based survey of recurrent non-specific low-back pain prevalence and consequences in children. Health Education Research 2004 Jun; 19, 284-289. 
18. Salminen JJ, Erkintalo MO, Pentti J, Oksanen A, Kormano MJ (1999) Recurrent low back pain and early disc degeneration in the young. 200. Spine. 24, 1316-1321. 
19. Croft PR, Lewis M, Papageorgiou AC, Thomas E, Jayson MI, Macfarlane GJ, Silman AJ (2001) Risk factors for neck pain: a longitudinal study in the general population. Pain. 93, 317-325. 
20. Clinical Guidelines for the Management of Acute Low Back Pain Royal College of General Practitioners 1999

Source: Backpain.org