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In modern society, one would be hard-pressed to overestimate the impact of low back pain (LBP). The costs of this problem, in both human suffering and dollars, are staggering. Although figures vary widely, the lifetime prevalence of LBP is usually quoted as ranging from 60% to 85%, with an annual rate of about 5%. In one recent study, the point prevalence of LBP was estimated to be 30%.


LBP is the number one cause of worker absenteeism in the United States and most other countries in the industrialized world. In the United Kingdom, it is responsible for 12.5% of all sick days. A 1985 study estimated that 14% of the entire population of the United States misses at least 1 workday per year because of LBP. This figure is highest among people involved in manual labor, with low job satisfaction and poor workplace social support. About 2% of workers each year submit claims for disability from LBP, making it the leading cause of expenditures for workers’ compensation.


The chance of someone with LBP returning to work full-time after any significant absence declines exponentially over time. For example, after 6 months of disability, the chance of someone with LBP returning to work full-time is about 50%. After 1 year, this figure plummets to below 20%. After 2 years of missed work, less than 3% of disability patients will ever work regular jobs again. The economic cost of this epidemic is estimated by some experts to exceed $100 billion per year, not to mention the physical, emotional, and psychological tolls it exacts.


Where does all this back pain come from, and who are the people most at risk? Overall, the ratio between men and women is about equal, although younger patients with LBP tend to be disproportionately male, and women report more LBP after the age of 60. For both sexes, the incidence increases with age. Postacchini and colleagues suggested that genetics may play a role in certain types of LBP. In patients with discogenic LBP and those who had undergone surgery for a herniated disk, 35% and 37%, respectively, had at least one first-degree relative with a history of discogenic pain, versus 12% in the control group. In these same two groups, 5% and 10% of patients, respectively, also had at least one family member who had undergone disk surgery, compared to only 1% of patients without complaints of LBP.


Many studies have shown an association between LBP and poor general health. Obesity (and possibly excessive height as well), smoking, low levels of physical activity, and poor strength and flexibility all predispose people to LBP. Interestingly, jobs involving heavy physical labor, and participation in certain sports such as wrestling and gymnastics, have likewise been associated with back pain. Studies have also demonstrated an increased number of sick days taken for other disorders in workers with LBP, and an association between LBP and chronic illness.


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