PainRelief.com Interview with:
Eric Roseen, DC, MSc
Director of the Program for Integrative Medicine and Health Disparities
Boston Medical Center
Assistant Professor of Family Medicine
Boston University School of Medicine
PainRelief.com: What is the background for this study?
Response: More than 80 percent of Americans will experience back pain at some point in their lives. Back pain is the leading cause of disability worldwide, and disability and inactivity are generally associated with greater mortality. Women and older adults, and those that experience more severe or persistent back pain, have an elevated risk of back-related disability. We were interested in whether back pain, in general or in these potentially at-risk subgroups, is associated with mortality. Thus, we conducted the first systematic literature review and meta-analysis of the association of back pain and all-cause mortality.
PainRelief.com: What are the main findings?
Response: Our results were published at the Journal of General Internal Medicine (DOI: 10.1007/s11606-021-06732-6<http://dx.doi.org/10.1007/s11606-021-06732-6>). We identified 11 studies with 81,337 adults. Age did not appear to have an effect on the association between back pain and mortality in our review, an unexpected result considering that past research has shown the impact of back pain on disability increasing with age. The highest risk of mortality associated with back pain was observed in studies that only included women and those with severe back pain.
PainRelief.com: What should readers take away from your report?
Response: We identified an elevated mortality risk for women with back pain when compared to women without back pain. Back pain was not associated with mortality among men, indicating that the long-term consequences of back pain may differ by sex. According to the overall findings, mild back pain (pain that does not keep a person from exercising or doing daily activities) is unlikely to impact the length of one’s life, but risk of mortality is increased among adults with more severe back pain.
In other words, back pain that is temporary, mild, or does not interfere with daily activities does not appear to be a risk factor for early mortality. However, if back pain is more persistent, frequent, or activity-limiting then it may be associated with mortality.
Proper management of back pain is important, and can help people stay active. This is especially important as the opioid epidemic has been exacerbated the COVID-19 pandemic, which has impacted people seeking medical care, their stress-levels, and their working environments. Non-pharmacologic treatments are recommended as first-line treatment of back pain including acupuncture, chiropractic care, massage, and physical therapy. There is evidence that these treatments are effective for managing back pain, and they are considered safe. Other treatments are known to have potentially serious side effects, such as steroid injections and opioids for pain management. Countless Americans have died as a result of the opioid epidemic, and low back pain is among the most common reasons why opioids are prescribed. The Centers for Diseases Control and Prevention<https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm> released a report this week highlighting the continued impact of the epidemic, with 87,000 Americans dying of overdose in the past year (ending September 2020), the highest number of overdose deaths ever recorded.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: I hope this study will lead to a better understanding of the long-term impacts of activity-limiting back pain on overall health and the research to improve back pain treatment over the course of patients’ lives. Future studies should also focus on the complex relationships between back pain, back pain treatment, mental health, disability, and mortality.
Most of the individual studies of men in our review did not distinguish between severe and mild forms of back pain. We also noticed that incomplete data on some demographic groups (e.g., racial or ethnic minorities, low-income adults) may limit the generalizability of our findings to understudied populations. Future studies should address these limitations.
PainRelief.com: Is there anything else you would like to add?
Response: This review was a follow-up study from an analysis of a large cohort of older women with back pain. That study was also published at the Journal of General Internal Medicine (DOI: 10.1007/s11606-018-4680-7<https://doi.org/10.1007/s11606-018-4680-7>)
Roseen, E.J., Rajendran, I., Stein, P. et al. Association of Back Pain with Mortality: a Systematic Review and Meta-analysis of Cohort Studies. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-021-06732-6
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