Back Pain: A Public Health DilemmaBack pain continues to be a major health problem around the world -- one that costs the health care system a great deal of money. Studies show that there can be minimal pain but huge disability and vice versa: significant pain but low disability. Finding a uniform way to approach the problem of back pain is difficult with such a wide range of experiences. Some patients need help with pain control while others need to improve their functional level.
The authors of this study from Germany attempted to answer two questions: first, what does back pain look like in the adult German population in terms of severity of pain and level of disability? This type of information could help health care systems provide what patients really need by focusing on the biggest problem area (pain vs. function) instead of treating everyone the same with only moderate success.
Second, is there some way to categorize patients with low back pain that could help direct more specific treatment to each subgroup? Along these same lines, the question arises -- should pain and disability be treated as two separate problems or approached as two factors associated with the same problem?
Data was used from a mailed in survey sent to residents of five German urban (city) areas. All participants were between the ages of 18 and 75. Questions were asked about the presence and severity of back pain and loss of function (disability). The first question asked was, Do you have back pain today? From there everyone answered a wide range of questions about pain in the last three months -- worst pain, number of disability days, and the number of days pain interfered with daily tasks, social events, or work.
Other studies have shown that 80 per cent of the adult population in developed countries will experience back pain at some time in their lives. This study showed that at any one given time (during the time the survey was conducted), two-thirds (63.7 per cent) had back pain. About half of those adults reported low intensity back pain. Only seven per cent had high pain intensity/low disability. It's the remaining (almost half) of the group that interests these researchers.
How do we classify that middle gray area? They don't have one single descriptor to characterize them. By analyzing the data several different ways, the authors were able to see five subgroups. These were labeled:
The authors point out that the five subgroups could change with different patient groups. Their group was from the general (urban) adult German population. Other standards of measure currently being used (e.g., Graded Chronic Pain Status (GCPS) scale) look at groups of chronic pain patients -- their groupings may yield different results. Cut-off points from group to group will likely vary depending on who is being studied.
The take home message from this study for health care providers (especially local health departments) is two-fold: 1) back pain is far more common each day than was known previously and 2) treatment should address both pain intensity and disability. As you can see from this list, as the pain increases, so does the disability. The number of folks with high intensity of pain and low disability is fairly low. This answers the question of whether pain and disability be treated as two separate problems (No) or approached as two factors associated with the same problem (Yes).
Carsten Oliver Schmidt, et al. Graded Back Pain Revisited -- Do Latent Variable Models Change Our Understanding of Severe Back Pain in the General Population? In PAIN. Vol. 149. No. 2010. Pp. 50-56.
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