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Causes/risk factors

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Back pain, an economic factor

Almost everyone knows what back pain is: your back hurts and suddenly sitting, bending over or straightening up is uncomfortable.
A review of the known studies published in Germany on the phenomenon of back pain indicates that the current frequency of back pain in adults has a point prevalence of about 40%. Point prevalence is a statistical parameter indicating the number of persons affected by a given disease or attribute (such as back pain) in a defined population (such as adults in Germany) at a given point in time. Factoring in lifespan prevalence, one can conclude that over 80% of all the adults in Germany have suffered from back pain at some point over the course of their lives. Most back pain sufferers are between 30 and 50 years of age. Incidents of back pain are on the increase in adolescents. One can assume that 40% of 14-19-year-olds in Germany suffer from repeated bouts of back pain. Back pain has developed into Germany's no. 1 widespread illness.
In economic terms, back pain costs a lot of money:

  • In the neighborhood of 25-30 billion euro is spent every year in Germany on diagnostics and therapy, the costs for work disability days, and early retirement due to back complaints.
  • About 40% of all medically certified work disability cases are due to back pain.
  • About 20% of all early retirements are due to chronic spinal column ailments
  • About 10% of all cases of acute back pain turn chronic
  • Chronic back pain patients account for as much as 80% of total costs generated by a ”back pain” diagnosis
  • Back pain accounts for over 10 million days missed at work every year

What are the causes and risk factors for back pain?

Back pain does not qualify as an independent diagnosis per se, but must rather be understood as a complex combination of symptoms and individual factors with biological, social and psychological components:
  • Biological
    • Degenerative changes
    • Advanced age
    • Trauma
    • Deficits and imbalances in trunk-stabilizing muscles
  • Social
    • Job requiring heavy physical labor or one-sided posture (e.g. long periods of sitting or standing, working bent over)
    • Low level of professional qualification or dissatisfaction with job
    • Lifestyle causes: smoking, excess weight, lack of exercise, poor physical condition and lack of activities to balance out work and everyday life.
  • Psychological
    • Anxiety, depression
    • Overextension
    • Stress, everyday conflicts
    • Somatization disorder
    • Posttraumatic stress disorders

Biological factors are now no longer considered to be the sole cause of spinal column symptoms. Although the radiological signs of spinal column wear increase with age, the number of back pain patients tends to decrease with age. Back pain is also frequently initiated at trigger points. Trigger points are areas in the tissue that react sensitively to pressure with pain. Myofascial trigger points are points in muscles, muscle fasciae, and tendons up to 1 cm in size that may cause pain. Pain can be ”projected” into other regions from these trigger points. This type of pain is frequently observed at the back of the head (occiput), the back, the nape of the neck and the shoulders. Tender trigger points may set off chain reactions, especially in muscle tissue. Overloading a muscle, or favoring it in response to muscle pain, causes the affected muscle to contract and tense up, resulting in a localized circulation deficiency in the muscle tissue. The patient may respond by favoring this area to ease the pain, causing other muscle groups to tense up, producing more trigger points and further exacerbating the pain.

Are there any indicators for a risk of chronification or for the presence of complex back pain?

The following signs are designated symbolically as ”yellow flags” that signal the risk of a chronification of back pain:
  • Persistent and returning back pain symptoms
  • Work disability periods exceeding 4-6 weeks
  • Radicular pain
  • Low level of education
  • Improper attitude and unrealistic expectations regarding the illness, depression
  • Pronounced malaise and intensive experience of illness
  • Poor handling of pain
  • Persistent everyday stress at work and at home
  • Desire to retire

The following signs are designated symbolically as ”red flags” that signal the possibility of complex back pain:

  • Worsening of back pain despite treatment
  • Neurological deficits, paralytic symptoms
  • Prior illnesses such as rheumatism, osteoporosis, tumor diseases
  • Fever in connection with back pains
  • Systemic cortisone treatment
  • Immunosuppression
  • Serious trauma in medical history