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Epidemiological Differences Between Localized and Nonlocalized Low Back Pain

Coggon D 1 , Ntani G 1 , Walker-Bone K 1 , Palmer KT 1 , Felli VE 2 , Harari R 3 Show all authors , Barrero LH 4 , Felknor SA 5 , Gimeno D 5 , Cattrell A 6 , Vargas-Prada S 7 , Bonzini M 8 , Solidaki E 9 , Merisalu E 10 , Habib RR 11 , Sadeghian F 12 , Kadir MM 13 , Warnakulasuriya SS 14 , Matsudaira K 15 , Nyantumbu B 16 , Sim MR 17 , Harcombe H 18 , Cox K 1 , Sarquis LMM 19 , Marziale MH 20 , Harari F 3 , Freire R 3 , Harari N 3 , Monroy MV 4 , Quintana LA 4 , Rojas M 21 , Harris EC 1 , Serra C 7 , Martinez JM 22 , Delclos G 5 , Benavides FG 7 , Carugno M 23 , Ferrario MM 8 , Pesatori AC 23 , Chatzi L 9 , Bitsios P 24 , Kogevinas M 25 , Oha K 26 , Freimann T 27 , Sadeghian A 28 , Peiris-John RJ 29 , Sathiakumar N 30 , Wickremasinghe AR 31 , Yoshimura N 32 , Kelsall HL 17 , Hoe VCW 33 , Urquhart DM 17 , Derrett S 34 , McBride D 18 , Herbison P 18 , Gray A 18 , Salazar Vega EJ 35

Affiliations 

  • 1 Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  • 2 School of Nursing, University of São Paulo, São Paulo, Brazil
  • 3 Corporación para el Desarrollo de la Producción y el Medio Ambiente Laboral - IFA (Institute for the Development of Production and the Work Environment), Quito, Ecuador
  • 4 Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia
  • 5 Southwest Center for Occupational and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
  • 6 North East London NHS Foundation Trust, Goodmayes Hospital, Ilford, Essex, UK
  • 7 Center for Research in Occupational Health (CiSAL), Universitat Pompeu Fabra, Barcelona, Spain
  • 8 Epidemiology and Preventive Medicine Research Centre, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
  • 9 Department of Social Medicine, Medical School, University of Crete, Heraklion, Greece
  • 10 Institute of Technology, Estonian University of Life Sciences, Tartu, Estonia
  • 11 Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  • 12 Department of Occupational Health, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
  • 13 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
  • 14 Department of Allied Health Sciences, Faculty of Medical Sciences, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
  • 15 Department for Medical Research and Management for Musculoskeletal Pain, 22 Century Medical and Research Center, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan
  • 16 National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
  • 17 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  • 18 Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  • 19 Federal University of Paraná, Curitiba-PR, Brazil
  • 20 School of Nursing of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
  • 21 Program Health, Work and Environment in Central America, Institute for Studies on Toxic Substances (IRET), National University of Costa Rica, Heredia, Costa Rica
  • 22 Servicio de Investigación y Análisis IT/EP, Departamento de Investigación y Análisis de Prestaciones, MC Mutual, Barcelona, Spain
  • 23 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
  • 24 Department of Psychiatry, Medical School, University of Crete, Heraklion, Greece
  • 25 CIBER of Epidemiology and Public Health, Barcelona, Spain
  • 26 North Estonia Medical Centre, Tallinn, Estonia
  • 27 Tartu University Hospital, Tartu, Estonia
  • 28 Klinikum Leverkusen, Leverkusen, Germany
  • 29 Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
  • 30 Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
  • 31 Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
  • 32 Department of Joint Disease Research, 22 Century Medical and Research Center, University of Tokyo, Tokyo, Japan
  • 33 Centre for Occupational and Environmental Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 34 Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  • 35 Health Safety and Environment Department, AkzoNobel, Houston, TX
Spine (Phila Pa 1976), 2017 May 15;42(10):740-747.
PMID: 27820794 DOI: 10.1097/BRS.0000000000001956

Abstract

STUDY DESIGN: A cross-sectional survey with a longitudinal follow-up.

OBJECTIVES: The aim of this study was to test the hypothesis that pain, which is localized to the low back, differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain.

METHODS: We analyzed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability, and potential risk factors, in 47 occupational groups (office workers, nurses, and others) from 18 countries.

RESULTS: Among 12,197 subjects at baseline, 609 (4.9%) reported localized LBP in the past month, and 3820 (31.3%) nonlocalized LBP. Nonlocalized LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, nonlocalized LBP was differentially associated with risk factors, particularly female sex, older age, and somatizing tendency. There were also marked differences in the relative prevalence of localized and nonlocalized LBP by occupational group.

CONCLUSION: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP that occurs in association with pain at other anatomical locations.

LEVEL OF EVIDENCE: 2.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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