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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 9  |  Page : 1295-1304

Evaluation of low back pain frequency and related factors among people over 18 years of age


1 Dokuz Eylül University, Medical School Department of Neurosurgery, İzmir, Turkey
2 Gazi University Faculty of Medicine, Department of Public Health, Ankara, Turkey
3 Selcuk University Faculty of Medicine, Department of Neurology, Konya, Turkey

Date of Submission09-Jul-2019
Date of Acceptance15-Apr-2020
Date of Web Publication10-Sep-2020

Correspondence Address:
Prof. H Kaptan
Assoc. Prof. in Neurosurgery, Dokuz Eylül University, Medical School Department of Neurosurgery, 35750 Balçova-Izmir
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_351_19

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   Abstract 


Aims: The present study aimed to evaluate the incidence of LBP and related factors in over 18-year-olds. Materials and Methods: This research was a cross-sectional study involving individuals over 18 years of age with any complaints in the period from May 2015-June 2016 at different hospitals. The research data were evaluated by the SPSS 15.0 statistical package program. Descriptive statistics were presented as mean (±) standard deviation, median (min, max), frequency distribution, and percentage. Pearson's Chi-square test, Yates corrected Chi-square test, and Fisher's test were used as statistical methods. Statistical significance was accepted as P < 0.05. Results: A total of 5,989 people admitted during that period and 50% unknown frequency were taken to reach 1715 subject persons with 2% deviation and 95% confidence interval which reached 1720. The sociodemographic status, occupational conditions, the frequency of low back pain, and risk factors have been evaluated. Around 92.9% of individuals of 65 years of age and older have lifelong LPB while 57.1% have present LBP. The difference was statistically significant for “the satisfaction of working people” and “individuals working more than 41 h a week.” (P < 0.001). Conclusion: Low back pain is still a serious problem that can be avoided by ensuring optimal working conditions and a healthier life.

Keywords: Cross-sectional study, low back pain, people over 18 years of age, prevalence


How to cite this article:
Kaptan H, Ilhan M N, Dikmen A U, Ekmekci H, Ozbas C. Evaluation of low back pain frequency and related factors among people over 18 years of age. Niger J Clin Pract 2020;23:1295-304

How to cite this URL:
Kaptan H, Ilhan M N, Dikmen A U, Ekmekci H, Ozbas C. Evaluation of low back pain frequency and related factors among people over 18 years of age. Niger J Clin Pract [serial online] 2020 [cited 2020 Sep 24];23:1295-304. Available from: http://www.njcponline.com/text.asp?2020/23/9/1295/294681




   Introduction Top


Low back pain (LBP) is a common disorder involving the muscles, nerves, and bones of the back. It is defined as pain, muscular tension, or stiffness that is localized between the costal margins and the inferior gluteal folds. Besides, symptoms of LBP may be due to either intrinsic or extrinsic factors (I). Those who have spent extended periods in a seating position at work as well as during leisure time, overweight, mental and emotional tension, smokers, those who do not exercise regularly, and fed unhealthy stuff constitute the main risk groups for back pain.[1] The lifetime prevalence of back pain is approximately 70% in most industrialized countries (III). In the USA, LBP is the second most common reason for visiting a physician and the third most frequent cause of hospital admission.[1],[2],[3],[4],[5]

The lifetime prevalence is 83.3% in Canada, 69.6% in Norway, and 60.7% in Sweden. In our country, LBP is a frequent cause of presentation at the primary healthcare institutions and also the most common reason for the loss of manpower hours. The prevalence of LBP varies but generally ranges between 44.0 and 63.3%.[6],[7],[8],[9]

LBP is most commonly seen in individuals exposed to physical work activities such as heavy work, frequent bending down, sudden tough movements, repetitive tasks, and weight lifting. It is a physical and emotional burden on the patient and thereby a psychological, economic, and social consequences for their families. Long-lasting pain causes depression and poor quality of life (QoL) in patients and affects society considerably with work loss and economic losses. For this reason, LBP can significantly reduce the QoL of individuals and is the second most common reason for withdrawal from their job. Work-related muscular and skeletal system disorders have become an important public health problem due to loss of workforce, economic burden and quality of life, and psychological and social problems[1],[2],[4],[10],[11],[12] Many demographic, environmental, ergonomic, and work-related factors that cause LBP should be identified and preventive measures should be taken.

Therefore, this study aimed to evaluate the incidence of LBP and related factors in over 18-year-olds.

General knowledge

Around 80 adults experienced pain at any time during their lifetime, often at least once between the ages of 45 and 60 years. Besides, 25 to 50% of the working population develops LBP every year.[4],[6],[7],[9]

Pain can be acute or chronic. Acute pain is a biological symptom that occurs in the event of tissue damage due to disease or trauma. The definition of acute LBP is LBP up to the first 6 weeks. If pain is a disease process and is longer than 3 months, it is defined as chronic pain.[2] Around 90% LBP heals within 12 weeks, 10% is chronic. LBP is not only acute or chronic; it can also be a recurrent structure that goes with attacks over time. Around 40–50% of patients suffering from pain are recovered within 1 week, 51–86% in 1 month, and 92% in 2 months. In 60% of those with painful episodes, recurrence is seen within 1 year. LBP is a serious problem both in terms of public health and loss of man-hours. The disability rate due to LBP is 3–6% per year. Chronic LBP has been the leading cause of chronic disability in working life since 1990. The incidence of lifelong waist pain is 80%, the annual incidence is 2%, and the prevalence is 15–39%.[1],[2],[4],[5],[8]

In their work on the epidemiology of LBP, Croft and colleagues divided the course of the condition into four main groups. First group; 60–80% of people have back pain at any time of their life, 2nd group; 35–40% of people describe waist pain that lasts 24 h or more each month, and 15–30% of them suffer from back pain every day, 3rd group; acute attacks recur, despite the rapid recovery, 4th group; the strongest predictor of LBP again was the fact that they had previously had back pain. Prevalence in LBP may vary with age. LBP can start at any age and as the age increases, the incidence increases. According to the US National Health and Nutrition Examination Survey definition, the prevalence is highest in the age group of 45–54 years.[6],[7],[10],[11]

Individual and professional risk factors for LBP

These factors are quite extensive. All the data are summarized in [Table 1].
Table 1: Risk factors for low back pain and explanations for risky conditions

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Diagnosis

The majority of LBP is caused by mechanical stress. The most common of these are muscle stiffness, lumbar spine, and calcification. The course is good at mechanical disorders. Most of the painful attacks heal in a short time. Lumbar pain is a nonspecific condition that can be defined as acute and chronic pain and discomfort due to complaining of inflammatory, degenerative, neoplastic, gynecological, traumatic, metabolic, and other types of disease near the lumbosacral region. Many conditions such as sciatica, lumbago, spondylosis, osteoarthrosis, and degenerative disc disease are associated with LBP. However, in working life, it may not be possible for many back pains to have a definite cause. For this reason, no specific cause has been found in many epidemiological studies of occupational LBP.

The diagnosis of LBP is usually made by clinical examination. But in some cases, X-ray films and further investigations may be needed. First of all, a patient's history should be taken and a physical examination should be performed. Later, diagnosis is done and treatment is planned. Computerized tomography (CT) and MRI should be used in cases of nonresponsive, repetitive, neuronal-pressurizing, non-mechanical causes, and surgical treatment plan.[1],[2],[6],[7],[13]

Prevention of LBP

Three out of four of the lumbar pain can be prevented by protection. Here are some important things to be done to protect which are as follows: a) improve posture, b) proper seating, c) proper sleep, d) driving in proper positions, e) tilting towards the front and correct weight lifting, f) stop smoking, g) ergonomic arrangements, h) exercise; the exercises which intend to strengthen the back, waist, and abdominal muscles, to facilitate healing, to prevent the recurrence, and settlement of pain.[2],[6],[7],[14],[15]

The impact of LBP on the QoL and scales used to assess LBP

LBP is a common complaint that reduces the QoL that people experience during their lifetime. In most cases, LBP is one of the most frequent and causes pain in those who visit primary healthcare facilities. LBP is a physical and emotional burden on the patient and has psychological, economic, and social consequences for her and her family. Spouses of patients with LBP may also not be satisfied with their marriage and sex life.

Prolonged pain causes depression and impaired QoL in patients. The most restricted activities due to LBP are lifting something, sitting, lying, standing, walking, traveling, social life, sleep, and sex life[2],[8],[9],[10],[12],[14],[16],[17] The demographic characteristics of the employees, history of LBP, and risk factors were determined by questionnaire forms filled in by themselves. The Oswestry Waist Pain scale was used to assess the functional deficits of employees. The hospital anxiety and depression scale (HAD) was used to measure risk, change in level, and intensity of anxiety and depression.[2],[8],[9],[10],[12],[14],[16],[17]

LBP usually tends to improve in the first month. Application of heat by heating pads, bed rest, and exercises may be useful. Non-steroidal anti-inflammatory drugs are the most common drugs used in the management. Gabapentin may also be preferred in patients with radiculopathy. Surgical treatment is successful in patients with LBP and radiculopathy who cannot receive medical treatment.[13],[18],[19]


   Materials and Methods Top


This research is a cross-sectional study. The research data were evaluated by the SPSS 15.0 statistical package program. Descriptive statistics were presented as mean (±) standard deviation, median (min, max), frequency distribution, and percentage. Pearson's Chi-square, Yates corrected Chi-square test, and Fisher's test were used as statistical methods. Statistical significance was accepted as P < 0.05. Systematic sampling was used as the main method. By dividing the size of the universe into sample sizes (5989/1715 = 3.49), every third person who applied to the health institution was taken to the investigation. During the analysis, the body mass index (BMI) was calculated as kg/m2 and was <18.5 kg/m2 was weak, 18.5–24.9 kg/m2 normal, 25.0–29.9 kg/m2 overweight, 30.0–39.9 kg/m2 obese, ≥40 morbid obesity. During Chi-square analysis, the weak and normal group were overweight and obese and morbidly obese groups were combined and analyzed.[20]

When the educational status is analyzed, “primary school graduate” and “secondary school graduate” are combined as “primary school graduate and under,” “secondary school graduate” and “high school graduate” and “graduate-doctorate graduation” are combined and grouped as “college-university graduation.”

When the number of births are analyzed, they are grouped as “none,” “1–2 birth,” “3 and more number for birth.”

“Weekly working hour” is grouped as “40 h and less,” “41 h and more.” Analyzing the satisfaction of the working environment, groups were grouped as “satisfied,” “unsatisfied,” and “very satisfied.”

When the self-definition situation is analyzed, groups of “generally happy” and “sometimes happy” and are grouped and grouped as “unhappy” and “very unhappy” groups. When the sporting situation was analyzed, “less than 1 h,” “1–3 h,” and “4–6 h” groups were combined and analyzed as “≤6 h” weekly. “Transportations” are grouped by “minibus,” “bus,” and “metro.” “How they assess their health in general” is grouped as “bad” by combining “very bad” and “bad” and “good” by combining “good” and “very good.”

The main criteria for LBP are evaluated by the “Oswestry Low Back Pain Disability Questionnaire.”


   Results Top


The study involved individuals over the age of 18 years presenting with LBP. Around 1720 of the 5989 individuals were included in the study, with a statistically 2% deviation and 95% confidence interval. Lifelong LBP was 92.9% of individuals aged 65 years and over, 86% of individuals aged 45–54, and 82.5% of individuals aged 55–64. Around 57.1% of individuals aged 65 years and over, 43.1% of individuals aged 55–64, 38% of individuals aged 45–54 now have LBP. The difference is statistically significant (P < 0.001). The common demographic characters (i.e. gender, education, BMI, marriage status, number of birth) are all analyzed that It is statistically significant when compared to Long life LBP and present LPB (P < 0.001) [Table 2].
Table 2: Lifelong and present status of LBP according to the descriptive characteristics of individuals participating in the survey

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In general, housewives (88.4%–42.3%) and retired individuals (86%–42.6%) are often suffering from LPB; (P < 0.001). Around 42.3% of housewives and 42.6% of retired individuals currently have LBP. The differences are statistically significant (P = <0.001).

Nearly 77.1% of the individuals working 41 h and above weekly and 68.4% of the individuals working 40 h or less have previously experienced LBP. The difference is meaningful as for (P = <0.001). About 76.1% of those who are not satisfied with the work environment, 78.9% of those who are moderately satisfied, and 68.1% of those who are satisfied have previously experienced LBP. The difference is meaningful as for (P = <0.001) [Table 3]
Table 3: The situation of life and current status of waist pain according to some occupational and working characteristics of individuals attending the survey

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Conditions such as healthy life, chronic diseases, family history, daily walk distance, heavy physical works, and emotional status are important when compared to back pain. (P < 0.001). [Table 4]
Table 4: Lifespan and present status of LBP according to the descriptive characteristics of individuals participating in the survey

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According to the Oswestry Lumbar Scale; 49,6% of the participants stated that lumbar pain was not a serious problem in life, and 14.7% stated that they limited their daily life to advanced level. [Table 5]
Table 5: Oswestry Low Back Pain Disability Questionnaire scores with daily life disability as descriptive characteristics of individuals participating in the survey

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We showed our patient demographics in [Table 6]. When we evaluate all our patients; 64.4% of patients between 25–34 years of age; 60% of those under 24.9 for BMI; 70.1% of single people; 57.4% of college/university graduates; 64.5% of nulliparity; and 78.1% of students make up. All variables related to signs and symptoms of subjects are described in [Table 2], [Table 3], [Table 4], [Table 5], [Table 6].
Table 6: Restriction of daily life due to LBP according to Oswestry Low Back Pain Disability Questionnaire scores

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   Discussion Top


In this study, a significant relationship was found between LBP and age. Over the age of 65, the prevalence of LBP is around 90%. Approximately half of the participants aged 24 years and younger have LBP at least once in their lifetime. We showed when age is increased; the ratio of LBP complaints is increased with age in our results. Most studies in the literature support this situation.[1],[2],[3]

In this study, we found an increase in the restriction associated with LBP according to the Oswestry Low Back Pain Scale. This value is the highest with age 65 and over. This includes 3/4 of those patients. Nurses' Oswestry Lumbar Spine Scale scores were found to be high in the study conducted in a university hospital, and the difference between the Oswestry Lumbar Spine Scale scores and age was found statistically significant. Oswestry scale score increases statistically significantly as age increases.[1],[2],[3]

In this study, the first serious LBP was found to be between 20–40 years of age. Usually, this age range is the age of meeting business life and the youngest people working more often in jobs requiring heavy physical strength. However, in this study, the rate of first LBP for those in the age group of 40 and over is higher than the rate for applying to the health institution. However, the rates of applying to the health institution for those who have experienced the first lower back pain at the age of 41 and above are significantly higher. Limitations caused by LBP may reach more serious dimensions as the age increases, and also this may be due to the increase in the importance that individuals attach to their health as the age increases.

The majority of women participating in this study are housewives, and housewives are at more than one risk. They have to do housework in the negative posture, they are more exposed to heavy lifting and physical difficulties, and they often have to do housework without help from anyone.[1],[2],[3],[4],[14],[15],[21],[22],[23] Subjects with a BMI above 25 were found to have significant lifelong and current complaints of LBP. According to the Oswestry LBP Scale, the pain was found in more than half of the participants with VKI > 25.

Studies show that obesity and increased body weight are the potential risk factors for LBP and especially for lumbar disc diseases. The belly load is increased in overweight people. According to marital status, married and widowed individuals were significantly more affected by LBP than single and divorced (P < 0,001). In the literature, there are studies in which married people have a higher prevalence of LBP. In the same way, the existing LBP was found to be higher in married individuals than in the singles, but the observed difference was not statistically significant. There was a significant decrease in the lifetime and current incidence of LBP with an increase in education level. By the educational attainment, the rate of admission to the hospital decreased significantly. It has been reported that chronic LBP of individuals with low educational level is significantly more frequent.[2],[3],[6],[7],[8],[23],[24],[25],[26]

A low educational level was identified as a factor limiting daily life on the Oswestry Back Pain scale. In this study, no significant relationship was found between economic status and LBP. Heavy physical work in daily life, heavy lifting, push-pull, and frequent bending have had a high level of complaints of LBP. There was a significant increase in LBP with an increase in the number of births in women. Almost half of those who gave birth to 3 or more have applied to a doctor for LBP. When the occupational groups are examined in terms of LBP for life, the most pain is seen in housewives and retirees and least among students and unemployed. Approximately one-quarter of the employers and students are restricted in daily life while about 3/4 of the retirees limit their daily lives. In the studies, the risk was more pronounced for industrial workers, miners, heavy vehicle drivers, housewives, nurses, painters, and occupations that had to work at constant pressure. It should not be overlooked that exposure to continuous vibration increases the frequency, severity, and frequency of LBP. In our study, when employees as long-term standing were examined, there was no increase in LBP for life, but the prevalence of current LBP was found to be 37%. This is also statistically significant. It has been determined that long-term standers in the literature are a risk factor for LBP. A statistically significant relationship was found between forwarding bending and LBP in nurses.[2],[8],[21],[25],[26],[27],[28],[29],[30]

No significant difference was determined in applying to the healthcare facility when according to the weekly working hours, the stress conditions of the working environment, reproduction of the same job, the appreciation of the superiors, and the satisfaction of the working environment. This can be explained by the fact that the severity of LBP and the rate of daily life restriction are low as a consequence of the fact that the LBP of the above-mentioned group is generally related to psychological reasons rather than serious physical forcing. It was found that those who do not use chairs and tables suitable to support their waist in the place where they spend most of their time during the day have more frequent LBP, but they do not apply to a higher rate to health facilities. More than 6 h a week were found to lower LBP significantly. A 10-year prospective study found that LBP was less frequent in those who do continuous exercise and good physical activity daily (no sedentary, walking during the day, working out all muscle groups, etc.). It is known that sports are a protective factor against LBP. Factory workers reported more loss of working days due to LBP than those who had weak abdominal muscles due to less sportive activity. Altınel et al. found that LBP was higher in employees who had back pain in their families than in those who did not. This information can be considered as a genetic basis for the complaint of back pain in the light. In this study, it was observed that while there was a significant increase in LBP for lifetime smoking, it did not make a significant difference for the current back pain. The relationship between smoking and LBP is shown in the literature. Bejia and colleagues found 1.65 times higher back pain than nonsmokers. In the study titled “Determination of sleep and quality of life of patients with chronic LBP complaints,” which was done by Cumhuriye University. In this study, chronic LBP has been shown to cause sleep disturbance and lower QoL The inconsistency between the use of medication due to LBP and the frequency of referral to a doctor suggests the use of unnecessary and unconscious drugs. In this study, it can be concluded that the use of unreasonable drugs in society is a serious problem.[1],[2],[3],[5],[8],[14],[15],[23],[24],[30],[31],[32],[33]

According to the results of this study, lifelong LBP is a problem seen in four quarters of people.


   Conclusion Top


First of all, it is necessary to make a correct determination of this problem in the whole country and to take necessary preventive measures. It will be useful to conduct an accurate determination of the frequency and to examine various risk factors in more detail during the studies performed on the first step. In this study, lifelong LBP was found to be statistically significant in those who did not use orthopedic support suitable for supporting their lower back at the place where they spent most of their time during the day.

Health personnel should also be informed about treatment approaches for LBP. Educational activities should be organized for the students and their families to prevent musculoskeletal disorders. Lifelong LBP frequency was statistically significant in subjects aged 65 years and over. Attention should be paid to the care of the elderly. Training should also be given to using the body posture properly during movement to housewives.

For BMI 25 and over, the lifetime waist pain frequency was found to be statistically significant. The lack of urbanization in developing countries makes a limitation for optimal working places. For this reason, local governments should address this issue and create living spaces that allow them to exhort in the cities.

Community awareness about smoking problems including back pain and smoking cessation should be increased.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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