Why should we care about low back pain?

An interview with low back pain expert Dr. Manuela Ferreira, Professor of Musculoskeletal Health at the University of Sydney and the first author of a new study on low back pain by IHME and Global Burden of Disease collaborators; and published in the journal The Lancet Rheumatology.   

Note: This interview was edited for length and clarity. 

Low back pain isn’t a topic that makes headlines very often. Why should people pay attention? 

Maybe not in the US, but in Australia, low back pain makes headlines often because it’s highly prevalent. Eight out of 10 people you know will tell you that they have had or have back pain.  

Why should policymakers be concerned about back pain? 

Back pain has been the main cause of disability globally since 1990. We haven’t really been able to address the problem. When you look at other conditions – for example, cardiovascular disease – in 1990, it ranked much higher as a cause of health loss than it does now. This is because there has been a lot of research, prevention strategies, and development of guidelines, and these efforts have decreased the burden of cardiovascular disease over the years. But with back pain, it’s still the number one cause of disability.   

How would you describe the impacts of back pain on society? 

First, there is the physical impact. We know that back pain affects people’s ability to move—bending down, walking, lifting, and twisting. It feels like you’re stuck. The physical impact of back pain is obvious and immediate. Over time, that will affect your ability to do normal tasks, such as cleaning the house, picking up kids from school, going to work, and driving. For example, we know that back pain is the number one reason for early retirement in Australia. It reduces people’s ability to work, especially if their work involves manual tasks. The research shows that back pain affects how much money people can make over their lifetime.  

Back pain affects quality of life, whether it is social, mental, or psychological. It is associated with a higher risk of depression and anxiety. People who have back pain are less likely to socialize, see their friends on the weekend, and spend time with their family. The impact of back pain keeps growing and getting much more significant.  

What will the situation look like in the future? 

What the paper showed is that it’s not going to get better. We expect around 800 million people will be living with back pain by 2050. The main drivers for the increase in prevalence are population growth and the aging of the population. If we don’t do something now, it’s going to get worse. People will be coming to see their health care provider(s) more often, so this will overload health care systems.  

Who is most affected by back pain? 

The peak prevalence occurs among older people – around 85 years of age – but it happens across the lifespan. Kids and teenagers are affected by back pain as well.  

What can be done to prevent back pain? 

We are not very good at preventing back pain. We know that the only thing that decreases your chance of having a new episode of back pain is physical activity. The only thing that you can do to avoid having back pain again is being physically active.  

However, the people who are most affected by back pain – older people – tend to get opioid prescriptions and surgery more often but get exercises and advice to stay active less often, which is what we know works for back pain. Policymakers, researchers, clinicians, patients, politicians, and hospital administrators need to join efforts to address this. 

If health care workers prescribed exercise and provided advice to people who are living with back pain more often, what financial impact would this have? 

It would have a huge positive impact. I can guarantee that opioids and surgery cost a lot more than exercise and advice.  

It would have a very positive impact on the lives of older patients with back pain because they are more likely to be living with multiple health challenges. When you prescribe opioids, for example, there is a high chance of a drug-drug interaction because they are already on other drugs. There is research showing that adverse events from opioids in older adults include falls and fractures, and consequently increased mortality.  

As individuals, what can people do to lower their chances of developing back pain?  

They can be physically active. They should engage in the activity that they enjoy for as long as they can tolerate. For older people, it could be gentle, light walking, for example. For younger people and children, it could be playing sports. 

There are also risk factors that we identified in the study, including obesity and smoking. These are not causes, but they are factors that will increase your risk of developing back pain.  

Where does your data on low back pain come from?  

The data came from over 100 countries. Most of the data comes from high-income countries. Fewer countries in Africa, South America, and Asia provided data on low back pain. However, these gaps in the data are well addressed by IHME because of the very sophisticated models and analyses that they do. So when we look at the results of this study – for example, low back pain affected 619 million people in 2020 – we need to take into account the level of uncertainty around that value. This is represented by the range in parentheses (554 to 694).