Chronic lower back pain: commonest cause for loss of working hours

Back pain is very common. now a days. Nine out of ten adults experience it at some point of their lives. The back of human being is designed to provide a great deal of strength, protecting the highly sensitive spinal cord and nerve roots, yet highly flexible and provide mobility in all direction. Back is also under continuous stress in normal daily activities and in risk of micro-injuries in excessively prolonged activities. There are a lot of reasons of back pain, although there are some serious underlying causes of it - in majority of the cases (80%-90%) cause of low back pain is nonspecific, with no identifiable cause.

Acute non-specific back pain is usually considered to be self-limiting (recovery rate 90% within 6 weeks) but 2-7% of patient develop chronic pain. The economic burden of low back pain is increasing and includes increasing days of absenteeism from work, loss of productivity and cost of treatment. Recurrent and chronic back pain is widely acknowledged to account for a substantial proportion of total workers absenteeism. About half of the days lost from work are accounted for by the 85% of the people are due to back pain. It is the leading cause of activity limitation and work absence throughout the world.

Most people who experiences activity limiting low back pain go on to have recurrent episodes. In addition to occupational factors there are many environmental and personal factors which influence the onset and course of low back pain. There is evidence that people suffering from stress, anxiety, depression, job dissatisfaction, low level of social support in working environment are at increased risk of suffering from back pain. Low back pain has an enormous financial and social impact upon the suffering individual.

Risk factor of back pain

Age: As the age increases wear and tear on the back results in degenerative changes (like disc degeneration, spinal stenosis) which predisposes back pain. This means that people over the age of 30 years are at more risk of back pain.

Excess weight: Excess weight puts relatively more pressure on spine causing stress and microinjuries to spine. Accumulating effect results in pain and accelerates spinal degeneration.

Sedentary lifestyle: People who are not physically active or do not perform regular exercises will not be able to maintain efficiently strong back muscle to support the spine and are likely to suffer more commonly from back pain.

Occupational hazards: Occupations that require repetitive bending and lifting has a high incidence of back injury (e.g. construction workers), jobs that require  prolonged hours of standing without a break (barber), sitting for a long time on a chair (e.g. software developer) that does not support the back also increases the risk of back injury put these persons at greater risk.

When back pain is associated with -  gradual increase in intensity of pain or felt during sleep; pain radiates to lower limbs and accompanied with numbness and weakness in legs; difficulty in controlling bowel and bladder; constant progressive back pain at night; significant weight loss; patient suffering from cancer and back pain that is not relieved by means of simple measures within 2-3 weeks, it is essential to seek advice from a doctor.

 The non-specific back pain is usually transient in nature and might need a short period of rest and simple analgesic for relief. In all such cases it is essential to prevent its recurrence by a policy that can reduce or prevent the initiating cause of it. A programmed back muscle strengthening exercise play a great role in preventing the recurrences.

Chronic back pain seems to be a biopsychosocial condition. Even though biological aspects like structural or anatomical causes have a great role, but also the psychological and social factors also play an important role which cannot be ignored.

The writer is a Professor of Orthopaedics.

Email: drghoshjc@gmail.com