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Tuesday, 26 November 2013

Chronic Low back pain – The Risk factors

Low back pain is a Musculoskeletal disorders (MSDs, affecting over 80% of the population in US alone some points in their life. Chronic LBP (pain has persisted for longer than 3 months(1) prevalence in older adults was significantly higher than the 21-to-44-year age group (12.3% vs. 6.5%, p < .001). Older adults were more disabled, had longer symptom duration, and were less depressed(2)..Many older adults remain quite functional despite CLBP, and because age-related comorbidities often exist independently of pain (e.g., medical illnesses, sleep disturbance, mobility difficulty), the unique impact of CLBP is unknown. We conducted this research to identify the multidimensional factors that distinguish independent community dwelling older adults with CLBP from those that are pain-free(3).
B. Risk factors of Low back pain
1. Aging
Elder is at higher risk  of chronic back pain due to discs degeneration(17a)
2. Repetitive bending and lifting can usually lead to severe back pain and sciatica over a period of 30 years as a result of ‘Annulus-driven’ disc degeneration involves a radial fissure and/or a disc prolapse, has a low heritability, mostly affects discs in the lower lumbar spine(17)
3. An increased risk for incident chronic LBP if exposed twice to awkward postures(18)
4. Sex, race and Lumbar symptoms
Musculoskeletal impairment was the most prevalent impairment in people aged up to 65 years, and spine impairments the most frequently reported subcategory of musculoskeletal impairment (51·7%). The annual rates varied significantly by sex and age (table 2). Back and spine impairments were more common in women (70·3 per 1000 population) than in men (57·3 per 1000 population), and more common among white people (68·7 per 1000 people) than black people (38·7
per 1000 people). In 1988, back and spine impairments resulted in over 185 million days of restricted activity (21·0 per impairment), which included 83 million days confined to bed (5·4 per impairment; table 3). About 56% of days of restricted activity occurred among women. Lumbar symptoms were
2·86 times more likely than thoracic symptoms to become chronic(19).
5. Smoking
Daily smoking increases the risk of LBP among young adults, and this effect seems to be dose-dependent. Back pain treatment programs may benefit from integrating smoking habit modification. The prevalence of chronic LBP was 23.3% in daily smokers and only 15.7% in non-smokers(20).
6. Psychiatric disorders are assciated to the inscreased risk of transition to chronicity in men with first onset low back pain(21)
7. Alcohol dependency
Alcohol consumption appears to be associated with complex and chronic LBP only and in people with alcohol consumption dependence(22).
8. Others
Occupational factors, presence of multiple functional symptoms, Disease-related factors, onorganic disease, pain in the legs, significant disability at onset, a protracted initial episode, multiple recurrences,   a history of low back pain, spinal condition, etc. are all assocoated with higher risk to develop chronic back pain(23).
9. Etc.
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Sources
Red flags*
Recent significant trauma, Milder trauma if age is greater than 50 years, Unexplained weight loss, Unexplained fever, Immunosuppression, Previous or current cancer, Intravenous drug use, Osteoporosis, Chronic corticosteroid use, Age greater than 70 years, Focal neurological deficit, Duration greater than 6 week(a)
(a) http://en.wikipedia.org/wiki/Low_back_pain 
(1) https://www.mja.com.au/journal/2004/180/2/management-chronic-low-back-pain
(2) http://jah.sagepub.com/content/22/8/1213.refs
(3) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2065872/
(17) http://www.ncbi.nlm.nih.gov/pubmed/22881295 
(17a) http://www.ncbi.nlm.nih.gov/pubmed/22892966
(18) http://www.ncbi.nlm.nih.gov/pubmed/21897339
(19) http://www.societyns.org/runn/2008/andersson_pain.pdf
(20) http://www.ncbi.nlm.nih.gov/pubmed/19796577
(21) http://www.ncbi.nlm.nih.gov/pubmed/20735749 
(22) http://www.ncbi.nlm.nih.gov/pubmed/23146385
(23) http://www.ncbi.nlm.nih.gov/pubmed/9090769