Background & Aims
Chronic back pain is a global health problem associated with years lived with disability1,2. An important challenge for the management of this condition is that patients with chronic back pain often present with other comorbidities3, such as heart diseases4,5, depression6, hypertension7-9, diabetes10 and metabolic-related disorders (ie, overweight/obesity and high cholesterol)7,8. Nevertheless, no studies have attempted to investigate the prevalence of clusters of comorbidities among adults with chronic back pain using data from a population-based study. The objective of this study was to identify the main clusters of comorbidities among adults with chronic back pain and to investigate the impact of comorbidities activity limitation due to chronic back pain.
Methods
This is a cross-sectional study with data from the Brazilian National Health Survey 2019. This survey is representative of Brazilian adults living in private households in urban and rural areas, the five geographic macro-regions, the 26 states and the Federal District, and state capitals11,12. A total of 88,531 adults participated in this survey. Of these, 18,930 people reported having chronic back pain and were included in our analysis. Chronic back pain was determined by a self-reported yes or no question. Similarly, participants were asked whether they have ever received a diagnosis of hypertension, heart diseases (such as infarction, angina, congestive heart failure or other), diabetes and depression. Activity limitation was measured in a 5-poin Likert scale (from no limitation to very severe). Descriptive statistics were reported with percentages and association investigated with adjusted logistic regression models and 95% confidence intervals (95% CI).
Results
The sample had a mean age was 51± 2.10 and most of the sample consisted of women (60.0%). Only 39.2% of participants did not present the comorbidities investigated. The prevalences found for each comorbidity were hypertension (36.9%), obesity (25.4%), depression (19.4%), diabetes (11.3%) and heart disease (9.8%). The most prevalent clusters of comorbidities were hypertension and obesity (5.6%), hypertension and depression (3.2%), hypertension and diabetes (2.8%), hypertension and heart diseases (2.4%). People with chronic back pain who reported at least 1 comorbidity reported high activity limitation (adjusted OR (ORa) =1.34; 95%CI: 1.26, 1.42) compared to those people with chronic pain but no comorbidities. The result of the association between activity limitation and comorbidities were depression (ORa=1.87; 95%CI: 1.65, 2.12), heart disease (ORa=1.33; 95%CI: 1.13, 1.56), obesity (ORa =1.25; 95%CI: 1.11, 1.40) and hypertension (ORa=1.24; 95%CI: 1.10, 1.41).
Conclusions
One third, one fourth and one fifth of those people with chronic spinal pain reported having hypertension, obesity, and depression, respectively. The presence of at least one comorbidity is associated with higher activity limitation. Depression, heart disease and obesity have impacted activity limitation in adults with chronic back pain.
References
1. Hoy, D. et al. A systematic review of the global prevalence of low back pain. Arthritis and Rheumatism 64, 2028–2037 (2012).
2. Vos, T. et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388, 1545–1602 (2016).
3. Hestbaek, L., Leboeuf-Yde, C. & Manniche, C. Is low back pain part of a general health pattern or is it a separate and distinctive entity? A critical literature review of comorbidity with low back pain. J. Manipulative Physiol. Ther. 26, 243–252 (2003).
4. Oliveira, C. B. et al. Co-occurrence of Chronic Musculoskeletal Pain and Cardiovascular Diseases: A Systematic Review with Meta-Analysis. Pain Med. (United States) 21, 1106–1121 (2020).
5. Rzewuska, M. et al. Epidemiology of multimorbidity within the Brazilian adult general population: Evidence from the 2013 National Health Survey (PNS 2013). PLoS One 12, e0171813 (2017)
6. Amiri, S., Behnezhad, S. & Azad, E. Back pain and depressive symptoms: A systematic review and meta-analysis. International Journal of Psychiatry in Medicine (2020). doi:10.1177/0091217420913001
7. Malta, D. C. et al. Factors associated with chronic back pain in adults in Brazil. Rev. Saude Publica 51, 1S-12S (2017)
8. Romero, D. E. et al. Prevalence, associated factors, and limitations related to chronic back problems in adults and elderly in Brazil. Cad. Saude Publica 34, (2018).
9. Schneider, S., Mohnen, S. M., Schiltenwolf, M. & Rau, C. Comorbidity of low back pain: Representative outcomes of a national health study in the Federal Republic of Germany. Eur. J. Pain 11, 387–397 (2007).
10. Pozzobon Id, D. et al. Is there an association between diabetes and neck and back pain? A systematic review with meta-analyses. (2019). doi:10.1371/journal.pone.0212030
11. Stopa, S. R. et al. Pesquisa Nacional de Saúde 2019: histórico, métodos e perspectivas. Epidemiol. e Serv. saude Rev. do Sist. Unico Saude do Bras. 29, e2020315 (2020).
.12. Szwarcwald, C. L. et al. Pesquisa nacional de saúde no Brasil: Concepção e metodologia de aplica ção. Cienc. e Saude Coletiva 19, 333–342 (2014).
Presenting Author
Jack Devonshire
Poster Authors
Rafael Zambelli Pinto - PhD
PhD
Federal University of Minas Gerais
Lead Author
Érica de Matos Reis Ferreira
MSc
Physical Therapy Department, Universidade Federal de Minas Gerais
Lead Author
Thaís Cristina Marquezine Caldeira
MSc
School of Medicine, Universidade Federal de Minas Gerais
Lead Author
Déborah Carvalho Malta
PhD
Maternal-Child and Public Health Nursing Department, Universidade Federal de Minas Gerais
Lead Author
Edmar Geraldo Ribeiro
Maternal-Child and Public Health Nursing Department, Universidade Federal de Minas Gerais
Lead Author
Eleonora Esposito
Physical Therapy Department, Universidade Federal de Minas Gerais
Lead Author
James McAuley
Neuroscience Research Australia, Universidade New South Wales,
Lead Author
Topics
- Epidemiology