Differences in physical and psychological health in patients with chronic low back pain: a national survey in general Spanish population

Abstract

Purpose

To estimate the prevalence of diagnosed and undiagnosed chronic low back pain (CLBP-D and CLBP-UD, respectively) in the general adult population in Spain and to compare the characteristics of these two groups with subjects without CLBP symptoms (No-CLBP). To establish CLBP-D patient sub-groups according to their self-perceived health status, mental health, level of pain and the impact of their pain on daily activities.

Methods

Data were obtained from the National Health Survey of Spain 2017 with a sample of 23,089 adults. Three groups were defined: CLBP-D, CLBP-UD and No-CLBP. In the CLBP-D group, a cluster analysis was performed to identify sub-groups. A multinomial regression model was constructed to determine the factors associated with each of the sub-groups identified.

Results

The prevalence of CLBP-D was 22% (95% CI 21.5–22.5) and that of CLBP-UD was 1.4% (95% CI 1.2–1.5). CLBP-D was more common in middle-aged females with a low educational level. They have a worse perceived health status, report more comorbidities, have worse mental health and more limitations in comparison with the populations without CLBP and with CLBP-UD. Three sub-groups of CLBP-D subjects were identified. Women and older subjects with a lower educational level, more occupational stress, less social support and with more physical limitations were the most likely subjects to be included in the group worst-affected.

Conclusions

There is a high prevalence of CLBP among the adult population in Spain. Occupational stress and a lack of social support are common factors among subjects’ worst-affected of CLBP-D and identifying the subjects with these risks is therefore a recommended strategy for improving the healthcare provided to CLBP patients.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    Institute for Health Metrics and Evaluation (IHME). (2018). GBD compare data visualization. Seattle: University of Washington.

    Google Scholar 

  2. 2.

    Maniadakis, N., & Gray, A. (2000). The economic burden of back pain in the UK. Pain. https://doi.org/10.1016/S0304-3959(99)00187-6.

    Article  Google Scholar 

  3. 3.

    Qaseem, A., Wilt, T. J., McLean, R. M., et al. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. https://doi.org/10.7326/M16-2367.

    Article  Google Scholar 

  4. 4.

    Hoy, D., Bain, C., Williams, G., et al. (2012). A systematic review of the global prevalence of low back pain. Arthritis and Rheumatism,64, 2028–2037. https://doi.org/10.1002/art.34347.

    Article  Google Scholar 

  5. 5.

    Helmick, C. G., Felson, D. T., Lawrence, R. C., et al. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis and Rheumatism. https://doi.org/10.1002/art.23177.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Reyes-Llerena, G. A., Guibert-Toledano, M., Penedo-Coello, A., et al. (2009). Community-based study to estimate prevalence and burden of illness of rheumatic diseases in cuba: A COPCORD study. J Clin Rheumatol. https://doi.org/10.1097/RHU.0b013e31819b61cb.

    Article  Google Scholar 

  7. 7.

    Louw, Q. A., Morris, L. D., & Grimmer-Somers, K. (2007). The Prevalence of low back pain in Africa: A systematic review. BMC Musculoskeletal Disorder. https://doi.org/10.1186/1471-2474-8-105.

    Article  Google Scholar 

  8. 8.

    Palacios-Ceña, D., Alonso-Blanco, C., Hernández-Barrera, V., et al. (2015). Prevalence of neck and low back pain in community-dwelling adults in Spain: An updated population-based national study (2009/10–2011/12). European Spine Journal. https://doi.org/10.1007/s00586-014-3567-5.

    Article  Google Scholar 

  9. 9.

    Fernández-De-Las-Peñas, C., Alonso-Blanco, C., Hernández-Barrera, V., et al. (2013). Has the prevalence of neck pain and low back pain changed over the last 5 years? A population-based national study in Spain. The Spine Journal. https://doi.org/10.1016/j.spinee.2013.02.064.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet. https://doi.org/10.1016/S0140-6736(16)30970-9.

    Article  Google Scholar 

  11. 11.

    Shiri, R., Karppinen, J., Leino-Arjas, P., et al. (2010). The association between obesity and low back pain: A meta-analysis. American Journal of Epidemiology. https://doi.org/10.1093/aje/kwp356.

    Article  Google Scholar 

  12. 12.

    Zhang, T. T., Liu, Z., Liu, Y. L., et al. (2018). Obesity as a risk factor for low back pain. Clinical Spine Surgery. https://doi.org/10.1097/BSD.0000000000000468.

    Article  Google Scholar 

  13. 13.

    Shiri, R., & Falah-Hassani, K. (2017). Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2016-097352.

    Article  Google Scholar 

  14. 14.

    Hartvigsen, J., Hancock, M. J., Kongsted, A., et al. (2018). What low back pain is and why we need to pay attention. The Lancet. https://doi.org/10.1016/S0140-6736(18)30480-X.

    Article  Google Scholar 

  15. 15.

    Pinheiro, M. B., Ferreira, M. L., Refshauge, K., et al. (2016). Symptoms of depression as a prognostic factor for low back pain: A systematic review. The Spine Journal. https://doi.org/10.1016/j.spinee.2015.10.037.

    Article  Google Scholar 

  16. 16.

    Wertli, M. M., Eugster, R., Held, U., et al. (2014). Catastrophizing—A prognostic factor for outcome in patients with low back pain: A systematic review. The Spine Journal. https://doi.org/10.1016/j.spinee.2014.03.003.

    Article  Google Scholar 

  17. 17.

    Wertli, M. M., Rasmussen-Barr, E., Weiser, S., et al. (2014). The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. The Spine Journal. https://doi.org/10.1016/j.spinee.2013.09.036.

    Article  Google Scholar 

  18. 18.

    Chou, R., & Shekelle, P. (2010). Will this patient develop persistent disabling low back pain? JAMA, the Journal of the American Medical Association. https://doi.org/10.1001/jama.2010.344.

    Article  Google Scholar 

  19. 19.

    Rabey, M., Slater, H., O’Sullivan, P., et al. (2015). Somatosensory nociceptive characteristics differentiate subgroups in people with chronic low back pain: a cluster analysis. Pain. https://doi.org/10.1097/j.pain.0000000000000244.

    Article  Google Scholar 

  20. 20.

    ENSE. (2017). Metodología Ministerio de Sanidad Consumo y Bienestar social (Vol. 64). Encuesta Nacional de Salud.

  21. 21.

    Carvalho, F. A., Morelhão, P. K., Franco, M. R., et al. (2017). Reliability and validity of two multidimensional self-reported physical activity questionnaires in people with chronic low back pain. Musculoskeletal Science and Practice. https://doi.org/10.1016/j.msksp.2016.12.014.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Bassett, D. R. (2003). International physical activity questionnaire: 12-Country reliability and validity. Medicine and Science in Sports and Exercise,35, 1396. https://doi.org/10.1249/01.MSS.0000078923.96621.1D.

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Goldberg, D. P., Lobo, A., Munoz, P. E., et al. (1996). Cuestonario de Salud General GHQ (General Health Questionnaire): Guia Para El Usario de Las Distintas Versiones. Barcelona: Masson.

    Google Scholar 

  24. 24.

    Härter, M., Reuter, K., Gross-Hardt, K., et al. (2001). Screening for anxiety, depressive and somatoform disorders in rehabilitation—Validity of HADS and GHQ-12 in patients with musculoskeletal disease. Disability and Rehabilitation. https://doi.org/10.1080/09638280110062176.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Bellón, J. A., Delgado, A., De Dios, L. J., et al. (1996). Validez y fiabilidad del cuestionario de apoyo social funcional Duke-UNC-11. Atención Primaria,18, 153–163.

    Google Scholar 

  26. 26.

    López-Martínez, A. E., Esteve-Zarazaga, R., & Ramírez-Maestre, C. (2008). Perceived social support and coping responses are independent variables explaining pain adjustment among chronic pain patients. The Journal of Pain. https://doi.org/10.1016/j.jpain.2007.12.002.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Gower, J. C. (1971). A general coefficient of similarity and some of its properties. Biometrics. https://doi.org/10.2307/2528823.

    Article  Google Scholar 

  28. 28.

    Jackson, T., Thomas, S., Stabile, V., et al. (2016). A systematic review and meta-analysis of the global burden of chronic pain without clear etiology in low- and middle-income countries: trends in heterogeneous data and a proposal for new assessment methods. Anesthesia and Analgesia. https://doi.org/10.1213/ANE.0000000000001389.

    Article  Google Scholar 

  29. 29.

    Fernández-De-Las-Peñas, C., Hernández-Barrera, V., Alonso-Blanco, C., et al. (2011). Prevalence of neck and low back pain in community-dwelling adults in spain: A population-based national study. Spine. https://doi.org/10.1097/BRS.0b013e3181d952c2.

    Article  Google Scholar 

  30. 30.

    Lopez-Valcarcel, B. G., & Barber, P. (2016). Economic crisis, austerity policies, health and fairness: Lessons learned in Spain. Applied Health Economics and Health Policy,15, 1–9. https://doi.org/10.1007/s40258-016-0263-0.

    Article  Google Scholar 

  31. 31.

    Urbanos-Garrido, R. M., & Lopez-Valcarcel, B. G. (2015). The influence of the economic crisis on the association between unemployment and health: An empirical analysis for Spain. The European Journal of Health Economics. https://doi.org/10.1007/s10198-014-0563-y.

    Article  Google Scholar 

  32. 32.

    Patel, S., Kai, J., Atha, C., et al. (2015). Clinical characteristics of persistent frequent attenders in primary care: Case-control study. Family Practice. https://doi.org/10.1093/fampra/cmv076.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Alford, D. P., German, J. S., Samet, J. H., et al. (2016). Primary care patients with drug use report chronic pain and self-medicate with alcohol and other drugs. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-016-3586-5.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Egli, M., Koob, G. F., & Edwards, S. (2012). Alcohol dependence as a chronic pain disorder. Neuroscience and Biobehavioral Reviews. https://doi.org/10.1016/j.neubiorev.2012.07.010.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Carrasco-Garrido, P., Hernández-Barrera, V., López De Andrés, A., et al. (2010). Sex-differences on self-medication in Spain. Pharmacoepidemiology and Drug Safety. https://doi.org/10.1002/pds.2034.

    Article  Google Scholar 

  36. 36.

    Matud, M. P., Bethencourt, J. M., & Ibáñez, I. (2015). Gender differences in psychological distress in Spain. International Journal of Social Psychiatry. https://doi.org/10.1177/0020764014564801.

    Article  Google Scholar 

  37. 37.

    Barnett, K., Mercer, S. W., Norbury, M., et al. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet. https://doi.org/10.1016/S0140-6736(12)60240-2.

    Article  Google Scholar 

  38. 38.

    Mills, S. E. E., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: a review of its epidemiology and associated factors in population-based studies. British Journal of Anaesthesia. https://doi.org/10.1016/j.bja.2019.03.023.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Müller-Schwefe, G., Morlion, B., Ahlbeck, K., et al. (2017). Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Current Medical Research and Opinion. https://doi.org/10.1080/03007995.2017.1298521.

    Article  Google Scholar 

  40. 40.

    Kabir-Mokamelkhah, E., Bahrami-Ahmadi, A., & Aghili, N. (2016). Work-related stress and quality of life among Iranian blue-collar workers with self-reported low back pain. Medical Journal of The Islamic Republic of Iran,30, 474.

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    Lindeberg, S. I., Rosvall, M., Choi, B., et al. (2011). Psychosocial working conditions and exhaustion in a working population sample of Swedish middle-aged men and women. European Journal of Public Health,21, 190–196. https://doi.org/10.1093/eurpub/ckq039.

    Article  Google Scholar 

  42. 42.

    Sterud, T., & Tynes, T. (2013). Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway. Occupational and Environmental Medicine,70, 296–302. https://doi.org/10.1136/oemed-2012-101116.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Hauke, A., Flintrop, J., Brun, E., et al. (2011). The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: A review and meta-analysis of 54 longitudinal studies. Work Stress,25, 243–256. https://doi.org/10.1080/02678373.2011.614069.

    Article  Google Scholar 

  44. 44.

    Hoogendoorn, W. E., Van Poppel, M. N. M., Bongers, P. M., et al. (2000). Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine,25, 2114–2125. https://doi.org/10.1097/00007632-200008150-00017.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Smeets, R. J. E. M., Vlaeyen, J. W. S., Kester, A. D. M., et al. (2006). Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. The Journal of Pain,7, 261–271. https://doi.org/10.1016/j.jpain.2005.10.011.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work was supported by a collaboration between the University of Cádiz and the Grünenthal Foundation. The Grünenthal Foundation is a private, non-profit organization that promotes the dissemination of scientific knowledge and supports research.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jose A. Moral-Munoz.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 22 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Dueñas, M., Moral-Munoz, J.A., Palomo-Osuna, J. et al. Differences in physical and psychological health in patients with chronic low back pain: a national survey in general Spanish population. Qual Life Res (2020). https://doi.org/10.1007/s11136-020-02553-y

Download citation

Keywords

  • Low back pain
  • Mental health
  • Chronic pain
  • Stress
  • Social support