More than 600 million people suffer from low back pain, which is the leading cause of disability in the world. health and wellness

The bench began complaining a long time ago: laments have been heard, according to some scientists, since the beginning of industrialization, which made the leap to modern life. But it also gave lifestyle changes, such as decreased physical activity, poor posture and furniture use, a cocktail that favored a spike in the bones of the lower back and the pain that accompanied it. Low back pain is one of the most frequent pain visits to the doctor’s office and is on the rise: A study published in the journal Lancet Rheumatology On the prevalence of this pathology, they estimate that in 2020 more than 600 million people in the world were suffering from it and it is estimated that in 30 years more than 800 million will be affected. The authors point to smoking, poor posture at work, and obesity as major risk factors for the disease, which already is and aims to be a leading cause of disability.

Low back pain (also called low back pain or lumbago) “between the twelfth rib and gluteal folds and that lasts a day or longer,” more or less in the lower back There is acute discomfort, define the study authors. Marcos Paulino, president-elect of the Spanish Society of Rheumatology, who did not participate in the study, welcomes the crystallization with data in a scientific journal he is used to seeing in consultations: “It’s an epidemic, some very often And it is a pathology that is difficult to prevent, because even if you recommend physical exercise, keeping a good weight and avoiding bad posture, 60% have low back pain that has no explanation. Only 40 % can be stopped.

The doctor, who is also head of the rheumatology service at the General University Hospital of Ciudad Real, assures that the lower back is “the sore heel of man, a very sensitive area that suffers more often.” “80% of the population will have low back pain at some point in their lives. The cool thing about this study is that it quantifies it and can overstate the magnitude of the problem”, he reflects. .

In the systematic review published this Tuesday Lancet Rheumatology, the authors used information from the 2021 Global Burden of Disease (GBD) study—a large, worldwide observational cohort of different types of pathology—to estimate the prevalence of low back pain between 1990 and 2020 in more than 200 countries. Epidemiological Investigation. Statistics have shown that 619 million people on the planet are affected by back pain in 2020 and there will be about 843 million people in 2050. The highest prevalence standardized over the years was found in Central Europe, especially in the Czech Republic and Hungary; The lowest prevalence was recorded in Maldives and Myanmar.

The increase is due to “population growth and aging trends” in the coming years, according to study author Garland Culbreth, a researcher at the Institute for Health Metrics and Evaluation at the University of Washington. “Population growth means more people, and population aging means more people in the most prevalent age groups, hence the increase in low back pain cases,” he said.

Since the condition was already, according to the authors, the first cause of disability, the researchers also measured the years spent with disability (YLD). This indicator reflects the impact of disease—in this case, low back pain—on quality of life and calculates that one YLD is a full year of healthy life lost due to disability or poor health. In 2020, the authors note, 69 million years were lived with disability due to low back pain, “and although the percentage of YLDs from all causes worldwide had decreased slightly since 1990, low back pain was still the main Was a contributor. YLD worldwide”, he explains.

Scientists have verified that the global prevalence is higher in women than in men in all age groups, although the years depend on the pathology: the prevalence of low back pain and years lived with disability increase with age, Groups 80 to 84 are the group with the highest rates. In fact, one-fifth of adults with low back pain report difficulties taking care of themselves at home or participating in social and family activities.

smoking, obesity and work

The authors point to smoking, obesity and ergonomics at work as the main risk factors, though not the only ones, that lead to low back pain. The risk of low back pain due to tobacco use was highest among middle-aged men and lowest among women aged 15–49, whereas the effect of working posture was greater among young adult men (15 years to 49 years). up to) and less than that had the highest. In women over 70 years. The risk of low back pain was highest among women aged 50 to 69 with a higher body mass index.

Study author Manuela Ferreira, a member of the Sydney Musculoskeletal Health Group at the University of Sydney, explains how tobacco works: “Smoking is associated with poor circulation in the spinal structures, for example, discs and joints, with as well as bone loss. But we also know that smoking is often associated with other lifestyle factors, such as physical inactivity, obesity, lack of sleep, all with an increased risk of low back pain. are connected.” The researcher also notes that a high body mass index (BMI) “may be associated with other unhealthy lifestyle factors that may increase the risk of low back pain, but it is also possible that a high BMI may affect the structures of the lower back.” But increases the load. Back.” spine, predisposing them to injury. Regarding occupational factors, Ferreira justifies their role: “Occupational factors that may contribute to the risk of developing low back pain include lifting heavy objects, sitting or standing for long periods of time, bending frequently and twisting of the torso, as well as stress and fatigue.”

The high prevalence of the disease worldwide, the researchers cautioned, “could have important social and economic consequences, especially given the substantial cost of care for the condition.” And they give one example: From 2012 to 2014, the direct cost for all people with spinal cord conditions in the United States was $315,000 million. Added to the economic burden of medical care for this pathology is the labor effect: its high prevalence in the active population causes absenteeism from work and even premature retirement: “In the United States, the workforce accounts for 1.5 percent of the labor force.” 15.4% report an average of 10.5 days of work lost per year due to chronic low back pain”, the study cites as an example.

ineffective drugs

The authors are wary of the potential effectiveness of certain drugs, noting that “paradoxically, the use of therapies with little or no efficacy may delay recovery and potentially increase the risk of long-term back-related disability and its As a result, the burden of this disease increases globally.” Many of the treatments currently offered to manage low back pain have little, no, or unknown efficacy. These include simple pain relievers, such as acetaminophen, and stronger ones, such as opioids, physical therapy (traction, ultrasound, transcutaneous electrical nerve stimulation), and several surgical procedures, such as surgical fusion. When these options are given to replace treatments that improve low back pain symptoms, such as exercise, psychological interventions and structured advice, they can delay recovery,” Ferreira said.

In the spotlight, above all, are opioids against pain: in Australia, for example, this class of drugs is the most commonly prescribed drug for low back pain. Against the backdrop of the very serious opioid epidemic in the United States, the researchers recall that opioids are “responsible for significant adverse health events” and caution against their use. “Not only is this strategy harmful because opioids are associated with serious adverse effects, including overdose death, but the benefits of opioids in improving pain and function in patients with low back pain are, at best, modest”, Deitch Ferreira.

Paulino acknowledges that improving the response to this pathology requires “time and resources.” “To properly address the problem, it takes time to get to know the illness well, to exercise or to learn relaxation techniques to deal with the pain. And we live in such a fast-paced society. The patient wants something quick, a pill, because they have to work or get back to their activities. If we had more time and resources the outlook would be better”, he reflects.

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