Prevalence of neck and low back pain in community-dwelling adults in Spain: an updated population-based national study (2009/10-2011/12)

Effects of Virtual Reality on Adults Diagnosed with Chronic Non-Specific Low Back Pain: A Systematic Review

BACKGROUND/OBJECTIVES

Non-specific low back pain represents a high number of primary care consultations, generating a great social and economic cost. There is a higher prevalence in women, and it may be associated with multiple factors. One of the most innovative tools in rehabilitation is virtual reality-based therapy. Virtual reality positively affects the motivation of participants and generates greater adherence to treatment, so this factor could lead to long-term functional improvement. The objective of this review is to update the effectiveness of virtual reality programs on pain, disability, kinesiophobia, and changes in the thoracoabdominal musculature in patients with chronic nonspecific low back pain.

METHODOLOGY

PubMed, PEDro, SCOPUS, Web of Science, and the Cochrane Library were used in this systematic review. The research question was formulated using PICOS. The Physiotherapy Evidence Database (PEDro) scale was used. Inclusion criteria were randomized clinical trials, participants were men and/or women over 18 years of age who were diagnosed with chronic non-specific low back pain, and articles that included virtual reality as a treatment. Articles with a level of evidence lower than 5/10 on the PEDro scale were excluded.

RESULTS

A total of 14 studies were included with sample sizes between 34 and 188 participants. Studies showed significant improvements in pain reduction, kinesiophobia, and disability (inflammation and motor control). Some studies showed long-term benefits, with effects maintained up to 18 months post-intervention, especially in the reduction in pain and its interference with daily activities.

CONCLUSIONS

The findings of this systematic review support the efficacy of virtual reality as an effective and safe therapeutic option for the treatment of chronic non-specific low back pain.

Effectiveness of pain neuroscience education, motivational interviewing and cognition targeted exercise therapy in patients with chronic neck pain: protocol for a multicentre randomised controlled trial (the COGMO-AP study)

INTRODUCTION

In primary care, the prevalence of neck pain has increased substantially. Evidence regarding treatment of chronic neck pain (CNP) is scarce, and its effectiveness is not entirely proven in different stages of chronicity, nor for different types of cervical disorders. The goal of this study is to evaluate the effectiveness of a complex intervention (COGMO intervention) compared with usual practice in primary care physiotherapy to improve neck pain intensity, severity and disability in patients with CNP.

METHODS AND ANALYSIS

Design: a pragmatic cluster-randomised clinical trial design with a 12-month follow-up.

SETTING

primary care.

PARTICIPANTS

physiotherapists as randomisation unit, and patients as analysis unit.

INCLUSION CRITERIA

individuals aged 18 to 65 years suffering from moderate to severe CNP. Sample size expected: 142 patients. Recruitment: patients referred from primary care physicians to physiotherapy.

INTERVENTION

pain neuroscience education (PNE), motivational interviewing (MI) and cognition targeted exercise therapy (CTE) compared with the standard treatment in primary care.

OUTCOMES

the main variable is reduction in pain intensity; secondary variables include pain severity, conditioned pain modulation, temporal summation, neck disability, fear/avoidance behaviour, kinesiophobia, catastrophising, therapeutic alliance and quality of life. Sociodemographic information and adherence to the intervention will be recorded.

DATA COLLECTION

baseline, and follow-up at 3, 6 and 12 months.

ANALYSIS

it will follow intention-to-treat principles, and difference in percentage of subjects achieving success on the primary endpoint at 12 months. A model with multilevel analysis will be adjusted through logistic regression (being the dependent variable pain intensity, and the independent, the intervention).

ETHICS AND DISSEMINATION

Ethical approval has been awarded by the Regional Ethics Committee of Madrid (code: COGMO-AP) and the primary health care central commission of research (code: 20210011). The results of the study will be disseminated through international peer-reviewed journals, international conferences, press and social media.

TRIAL REGISTRATION NUMBER

NCT05785455.

Digital devices usage and neck and shoulder pain among college students: a cross-sectional study in China

Neck and shoulder pain (NSP) is a common issue among college students, yet no studies have linked digital device usage to NSP prevalence in China. This cross-sectional survey aimed to explore this relationship among students in Shanghai. A total of 6,000 students were randomly selected, with 4,848 (80.8%) completing a self-reported questionnaire on NSP prevalence and severity. The results showed a 39.1% NSP prevalence, higher in females (45.0%) than males (32.4%). Logistic regression revealed significant correlations between NSP and factors such as gender, poor posture, and prolonged digital device use. Additionally, neck muscle activity increased with spinal inclination, as assessed by the AnyBody platform. The findings suggest promoting a healthy spinal curvature lifestyle to reduce NSP among college students..

The effectiveness of aerobic exercise on pain and disability in individuals with neck pain: A systematic review and meta-analysis

The present review aimed to investigate the effectiveness of aerobic exercise (AE) compared to other interventions in decreasing pain intensity and reducing disability in individuals with neck pain. A systematic review (SR) of randomized controlled trials was conducted. This SR was registered in PROSPERO (CRD42021231231). Searches were conducted in five electronic databases (MEDLINE, Embase, CINAHL, Cochrane and SCOPUS). Studies were selected if they included adults over 18 years old with neck pain. The primary outcomes were pain intensity and physical function. A meta-analysis was conducted when applicable. Cochrane RoB Tool-2 was used to determine the risk of bias of included studies, and the certainty of the evidence was determined using the GRADE approach. Out of 4669 initial records screened, six studies published in 12 articles were included. AE was not statistically different compared to no-treatment or other interventions (e.g., localized exercise or acupuncture) on pain intensity measured with a visual analogue scale (VAS) (mean difference (MD) [95%CI]: 5.16 mm [-6.38, 16.70]). Contrarily, strengthening exercise was better than AE for pain intensity (MD [95%CI]: -11.34 mm [-21.6, -1.09]) after treatment. However, when AE was combined with other therapy (strengthening exercises or acupuncture), the combined therapy was better than isolated treatments (MD [95%CI]: 7.71 mm [1.07, 14.35]). A high heterogeneity was observed between protocols, comparisons, and results (magnitudes and directions). In conclusion, AE had positive results only when combined with other therapies to reduce pain intensity and disability in patients with neck pain. However, the evidence is limited, low-quality, and heterogeneous.

Sociodemographic disparities and potential biases in persistent pain estimates: Findings from 5 waves of the Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

Pain is a prevalent, debilitating condition among older adults. Much evidence on this topic comes from cohort studies, which may be affected by attrition and measurement bias. Little is known about the impact of these biases on pain estimates for European older adults. Additionally, there is a lack of longitudinal research on pain and sociodemographic disparities in Irish older adults.

METHODS

We analysed data from 8171 participants (aged ≥50 at baseline) across five waves of the Irish Longitudinal Study on Ageing. Longitudinal pain severity and sociodemographic disparities in pain were explored visually and using a latent growth curve model. Using multivariate logistic regression, we examined bias due to attrition at later waves associated with reported pain at Wave 1. Measurement biases due to reporting heterogeneity were assessed by investigating associations between sociodemographic factors and pain-related disability for given pain levels.

RESULTS

Wave 1 severe pain was associated with increased odds of attrition due to death by Wave 5 (AOR: 1.63, 95% CI: 1.20, 2.19). Not having private health insurance was associated with increased odds of pain-related disability at Wave 1, controlling for pain severity (AOR: 1.37, 95% CI: 1.15, 1.64). These results suggested mortality bias and reporting heterogeneity measurement bias, respectively. Sex, education level, and private health insurance status disparities in pain were observed longitudinally.

CONCLUSIONS

Mortality bias and reporting heterogeneity measurement bias must be accounted for to improve older adult pain estimates. There is a need for policymakers to address sociodemographic disparities in older adult pain levels.

SIGNIFICANCE

This study highlights a need to address bias in the estimation of pain in observational studies of older adults. Understanding the sources and extent of these biases is important so that health practices and policies to address pain disparities can be guided by accurate estimates. Women, those with lower educational attainment, and those without private health insurance were found to have the highest pain burden longitudinally, suggesting a need for targeted interventions for these groups in Ireland and internationally.

Symptom burden and follow-up of patients with neck and back complaints in specialized outpatient care: a national register study

Back and neck pain are common in the population, especially among immigrants. In Norway's specialist care system, treating these patients typically involves a multidisciplinary approach based on the biopsychosocial model. However, language and cultural differences may create barriers to participation. Immigrants are often underrepresented in clinical studies, but a register-based approach can enhance their participation in research. This study aimed to compare both the symptom burden, and treatment, among Norwegians, non-Norwegians, and patients requiring translator service for back and neck pain within the Norwegian specialist care system. The Norwegian neck and back registry is a National Quality Register, established in 2012 and fully digitized in late 2020. The baseline data includes demographics and patient recorded outcome measures including Oswestry Disability Index, Fear-Avoidance Beliefs, pain rating on a numeric rating scale, Hopkins Symptom Checklist and EuroQol five-dimensional questionnaire on health related quality of life. During the two-year study period, a total of 14,124 patients were invited, and 10,060 (71%) participated. Norwegian patients reported less pain, better function assessed by Oswestry Disability Index, lower fear avoidance beliefs, less emotional distress, and higher health related quality of life compared to non-Norwegians. We found that patients with female gender, who were younger, more educated and exhibited fear-avoidance behavior were significantly more likely to receive multidisciplinary treatment. We found no difference in the proportion of Norwegian and non-Norwegian patients receiving multidisciplinary treatment [odds ratio (OR) 1.02 (95% confidence interval (CI) 0.90-1.16)]. However, patients needing a translator were less likely to receive multidisciplinary treatment compared to those who didn't require translation [OR 0.41 (95% CI (0.25-0.66)]. We found that non-Norwegian patients experience a higher symptom burden compared to Norwegian. We found that both non-Norwegians and patient in need of translator were to a greater extent recommended treatment in primary health care. The proportion of non-Norwegians patients receiving multidisciplinary treatment was similar to Norwegians, but those needing a translator were less likely to receive such treatment.

Effectiveness of Self-Care Education for Chronic Neck Pain: A Systematic Review and Meta-Analysis

Self-care programs for chronic neck pain are relevant to everyday life and can lead to long- term improvement. More studies on their effectiveness, key components and appropriate duration are needed. The aim of this study was to determine the effectiveness of self-care programs for patients with chronic neck pain. A systematic review and meta-analysis of randomized controlled trials was conducted according to the PRISMA guidelines. After searching in PubMed, Web of Science, Scopus and ScienceDirect, eleven studies met the inclusion criteria. Self-care education interventions typically consisted of education (i.e., pain neuro-science education or general educational concepts) accompanied by exercise or manual therapy. The most frequent components were addressing physical and psychological symptoms and engaging in self-care strategies. The least frequent ones were monitoring and recording symptoms and discussing with providers of medical care. The duration of the interventions ranged from three sessions to six months. Finally, individual and supervised modalities were the most frequent. After pooling the data, a meta-analysis was carried out according to four variables (i.e., pain, disability, kinesiophobia and catastrophization) and showed significant results (p < 0.05) in favor of self-care interventions. This systematic review and meta-analysis suggests that self-education interventions improve pain, psychological pain-related variables and disability in patients with chronic neck pain. The most frequently used components were addressing physical and psychological symptoms and engaging in self-care strategies. Future trials should focus on including other components, such as discussing symptoms with providers of medical care or self-monitoring symptoms. Additional areas of focus include more homogeneous doses and comparator treatments, as well as studies with better evidence to reach more solid conclusions.

Efficacy of pharmacological and non-pharmacological therapy on pain intensity and disability of older people with chronic nonspecific low back pain: a protocol for a network meta-analysis

BACKGROUND

The purpose of this network meta-analysis (NMA) is to investigate the efficacy of pharmacological and non-pharmacological therapy on pain intensity and disability of older people with chronic nonspecific low back pain, providing comprehensive evidence for an informed decision-making.

METHODS

We will perform a systematic search to identify randomized controlled trials of pharmacological and non-pharmacological interventions for older people with chronic nonspecific low back pain. MEDLINE, Cochrane Library, Embase, AMED, PsycINFO, and PEDro will be searched without language or date restrictions. Our primary outcomes are pain intensity and disability. Risk of bias will be assessed for all studies using the revised Cochrane risk-of-bias (RoB) tool 2.0. For each pairwise comparison between the different interventions, estimated mean differences and their 95% confidence intervals will be presented. Standard pairwise meta-analyses will be performed using random effects models in STATA version 16. The competing interventions will be ranked using the surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at short and long terms. The confidence in the results from NMA will be assessed using the Confidence in Network Meta-Analysis (CINeMA) framework.

DISCUSSION

This NMA compares efficacy of interventions for nonspecific chronic low back pain in older people. It will provide reliable evidence for patients, clinicians, stakeholders, and researchers in this field where competing therapies, many of extraordinarily little value, are commonly used in clinical practice.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022312565.

Predictors of Outcomes After Lumbar Intra-Articular Facet Joint Injections and Medial Branch Blocks: A Scoping Review

STUDY DESIGN

A scoping review.

OBJECTIVE

We aimed to identify and describe the factors associated with the patient-reported response after lumbar intra-articular facet joint (FJ) injections or medial branch blocks (MBBs).

SUMMARY OF BACKGROUND DATA

FJ osteoarthritis is among the most common causes of chronic low back pain. Management often includes FJ intra-articular injection and MBBs (which may be followed by radiofrequency ablation of the nerves innervating these joints). However, the success of these approaches is variable, prompting interest in identifying patient characteristics (imaging features, clinical signs, and among others) associated with response to these types of facet injections.

MATERIALS AND METHODS

We performed a literature search on factors associated with patient-reported outcomes after lumbar FJ intra-articular injections or MBBs for patients with low back pain published in English or Spanish between 2000 and 2023. We excluded duplicate papers that did not describe factors associated with outcomes or those describing other interventions. We collected data on the association of these factors with patient-reported outcomes.

RESULTS

Thirty-seven studies met the inclusion criteria and were analyzed. These studies evaluated factors, such as age, depression, and single photon emission computed tomography (SPECT), and among variables. Age and imaging findings of facet arthropathy were the most frequently described factors. Imaging findings of FJ arthropathy and positive SPECT were often associated with positive results after intra-articular FJ injections or MBBs. In contrast, younger age and smoking were frequently associated with less favorable clinical outcomes.

CONCLUSION

Numerous factors were considered in the 37 studies included in this review. Imaging findings of facet arthropathy, duration of pain, and positive SPECT were consistently associated with favorable results after facet interventions.

Effects of a Therapeutic Exercise Protocol for Patients with Chronic Non-Specific Back Pain in Primary Health Care: A Single-Group Retrospective Cohort Study

BACKGROUND

Back pain is highly prevalent; in Spain, it produces a very high economic cost and the scientific evidence supporting treatments shows low to moderate evidence for exercise. Therefore, the aim of this study was to assess the effectiveness of a therapeutic group exercise protocol in reducing pain intensity and disability in patients with back pain in primary health care setting.

METHODS

A total sample of 149 patients who suffered from chronic non-specific back pain was selected. Patients received a therapeutic exercise protocol, including auto-mobilization exercises for the neck and lumbar regions, as well as core stabilization exercises. Pain intensity and disability were evaluated before and after the therapeutic exercise protocol.

RESULTS

Statistically significant differences (p < 0.05) were shown in pain intensity and disability for patients with non-specific neck and low-back pain, with an effect size from moderate to large.

CONCLUSIONS

A therapeutic exercise protocol may provide beneficial effects upon disability and pain intensity in patients with chronic non-specific back pain, including neck and low-back pain conditions In addition, It could be considered for inclusion as a back-pain-approach program in primary healthcare.

Effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain: a systematic review with meta-analysis

BACKGROUND AND PURPOSE

The aim of the present systematic review was to investigate the effectiveness of pharmacological and non-pharmacological therapy on pain intensity and disability in older people with chronic nonspecific low back pain.

METHODS

Searches were conducted in the MEDLINE, COCHRANE LIBRARY, EMBASE, AMED, PSYCINFO, and PEDRO databases up to 2022. Risk of bias was appraised using the Cochrane Risk of Bias 2.0 tool. Estimated mean differences and respective 95% confidence intervals were presented for each paired comparison and the strength of the current evidence was assessed using the GRADE approach.

RESULTS AND DISCUSSION

Thirty-one original trials involving 2120 participants were included. All outcomes were self-rated. Pain intensity was measured using the Visual Analogue Scale or Numerical Rating Scale. Disability was evaluated using the Roland Morris Disability Questionnaire, Oswestry Disability Index or Hannover Functional Ability Questionnaire. Short-term: Moderate quality of evidence that mindfulness reduces disability compared to patient education (mean difference [MD] =  - 1.38 [95% CI - 2.02 to - 0.73]); low-quality evidence that mixed exercise (MD = - 50.33 [95% CI - 57.11 to - 43.56]) reduces pain compared to no intervention, waiting list, placebo or sham; low quality of evidence that there is no effect for opioid compared to placebo (MD = - 8.26 [95% CI - 19.29 to 2.77]) with regards to reducing pain and opioid/acetaminophen reduces disability more compared to pregabalin (MD = 2.36 [95% CI] 1.86-2.86]).

CONCLUSIONS

The findings showed low or very low quality of evidence for non-pharmacological interventions with a large effect in short- and long-term follow-up. The two studies that provided moderate quality of evidence had a small clinical effect. Only two studies were found that investigated pharmacological therapies-both with low quality of evidence. However, the studies were methodologically weak and had small sample sizes. Given the adverse effects of low back pain and the scarce information on the effectiveness of pharmacological and non-pharmacological treatments for older people, future randomized trials should be encouraged.

Prevalence of lower back pain and its associations with lifestyle behaviors among college students in Saudi Arabia

BACKGROUND

Lower back pain (LBP) is a common musculoskeletal disorder that may affect students' daily lives. Recent psychological research showed a relevant connection between LBP and multidimensional health. However, the association between LBP and lifestyle behavior has not been established, and improving knowledge in this area may help develop preventive strategies and optimize college students' quality of life.

METHODS

A cross-sectional study of 1420 college students in Saudi Arabia was conducted, and participants who attended Saudi Universities were recruited from May 2021 to November 2021. An established validated online survey assessed LBP, sleep quality, time spent sedentary (sedentary duration), health responsibility, physical activity, nutrition, spiritual growth, interpersonal relationships, and stress management. Generalized Linear Regression was used to assess the associations between LBP severity and lifestyle behaviors after controlling for covariates.

RESULTS

LBP was prevalent among college students from Saudi Arabia. Most of the sample were young (23.81 ± 6.02), and female (83.7%). There were significant differences between students with and without LBP regarding age, BMI, sex, marital status, pain severity, overall lifestyle behavior, health responsibility, physical activity, nutrition, stress management, and global sleep quality. After controlling for age, BMI, sex, and marital status, there were significant associations between pain severity and global sleep quality (ß=0.2, p < .001, CI: 16 to 0.24), and sedentary duration (ß=0.03, p = .01, CI:0.009 to 0.06).

CONCLUSIONS

This study helped define the prevalence of LBP in college students in Saudi Arabia and evaluated the association between LBP and lifestyle behaviors. The findings showed that students with higher levels of poor sleep quality or sedentary behavior had higher levels of pain. Promoting sleep quality and reducing sedentary behavior may help establish preventive strategies for LBP in college students.

Body Mass Index and Its Influence on Chronic Low Back Pain in the Spanish Population: A Secondary Analysis from the European Health Survey (2020)

Risk factors such as obesity and a sedentary lifestyle contribute to the development of chronic low back pain.

PURPOSE

To describe how body mass index (BMI) influences the prevalence of chronic low back pain in the general Spanish population and assess this influence given other factors as sex, age, physical occupational demands, and recreational physical activity.

METHODS

An analytical cross-sectional design was performed based on secondary data from the European Health Survey in Spain (2020). Data on age, gender, physical occupational demands, physical activity, BMI, and presence of chronic low back pain were extracted.

RESULTS

A total of 19,716 (52.2% women) subjects with a median age of 53 years old were analyzed. Of these, 18.3% had chronic low back pain, 39% were overweight, and 16.1% were obese. The adjusted generalized linear model showed that being obese increased the odds of chronic low back pain by 1.719 times (p < 0.001). Being a woman increased the odds by 1.683 times (p < 0.001). Performing occupational tasks requiring high physical demands increased the odds by 1.403 times (p < 0.001). Performing physical activity in leisure time several times a week decreased the odds by 0.598 times (p < 0.001). For every additional year of age, the odds of chronic low back pain increased by 3.3% (p < 0.001).

CONCLUSIONS

Obesity is related with the presence of chronic low back pain in the general Spanish population. This association persists, being the more relevant factor, after adjusting the association of BMI and chronic low back pain with other factors such as sex, age, physical occupational demands, and recreational physical activity.

Prevalence and morbidity of neck pain: a cross-sectional study of 3000 elderly men

BACKGROUND

The purpose of this study is to determine the prevalence and morbidity of neck pain with or without cervical rhizopathy, upper extremity motor deficit and/or thoracolumbar pain in elderly men.

METHODS

We conducted a cross-sectional questionnaire study of 3,000 community-dwelling older men with a mean age of 75.4 ± 3.2 years (range 69-81) to determine if they had experienced neck pain with or without cervical rhizopathy/upper extremity motor deficit/thoracolumbar pain (yes/no) during the preceding 12 months, and if so, morbidity with the condition (no/minor/moderate/severe).

RESULTS

Among the participants, 865 (29%) reported they had experienced neck and 1,619 (54%) thoracolumbar pain. Among the men with neck pain, 59% had experienced only neck pain, 17% neck pain and cervical rhizopathy and 24% neck pain, rhizopathy and motor deficit. For men with only neck pain, the morbidity was severe in 13%, for men with neck pain and rhizopathy it was 24%, and for men with pain, rhizopathy and motor deficit it was 46% (p < 0.001). Among the men with neck pain, 23% had experienced only neck pain and no thoracolumbar pain; the remaining 77% had both neck and thoracolumbar pain. The morbidity was severe in 10% of the men with neck pain but no thoracolumbar pain and 30% in men with neck and thoracolumbar pain (p < 0.001).

CONCLUSION

Neck pain in elderly men is common but symptoms and morbidity vary. For men who only have neck pain, 1/8 rated their morbidity as severe, while almost half who also had cervical rhizopathy and motor deficit and almost 1/3 of those who also had thoracolumbar pain reported severe morbidity.

A GBD 2019 study of health and Sustainable Development Goal gains and forecasts to 2030 in Spain

This study aimed to report mortality, risk factors, and burden of diseases in Spain. The Global Burden of Disease, Injuries, and Risk Factors 2019 estimates the burden due to 369 diseases, injuries, and impairments and 87 risk factors and risk factor combinations. Here, we detail the updated Spain 1990-2019 burden of disease estimates and project certain metrics up to 2030. In 2019, leading causes of death were ischaemic heart disease, stroke, chronic obstructive pulmonary disease, Alzheimer's disease, and lung cancer. Main causes of disability adjusted life years (DALYs) were ischaemic heart disease, diabetes, lung cancer, low back pain, and stroke. Leading DALYs risk factors included smoking, high body mass index, and high fasting plasma glucose. Spain scored 74/100 among all health-related Sustainable Development Goals (SDGs) indicators, ranking 20 of 195 countries and territories. We forecasted that by 2030, Spain would outpace Japan, the United States, and the European Union. Behavioural risk factors, such as smoking and poor diet, and environmental factors added a significant burden to the Spanish population's health in 2019. Monitoring these trends, particularly in light of COVID-19, is essential to prioritise interventions that will reduce the future burden of disease to meet population health and SDG commitments.

Time Trends and Sex Differences in the Association between Diabetes and Chronic Neck Pain, Chronic Low Back Pain, and Migraine. Analysis of Population-Based National Surveys in Spain (2014-2020)

(1) Background: To assess the time trend in the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine or frequent headache (MFH) among people with diabetes in Spain from 2014 to 2020, this study identified sex differences and compared the prevalence of these pain sites between people with diabetes and age−sex-matched non-diabetic subjects. (2) Methods: The study design included a cross-sectional and a case−control study. The data were obtained from the European Health Interview Surveys for Spain conducted in 2014 and 2020. The presence of diabetes, CNP, CLBP, and MFH was self-reported. Study covariates included sociodemographic characteristics, comorbidities, lifestyles, and pain-related variables. (3) Results: Among people with diabetes, the prevalence of CNP, CLBP, and MFH did not improve from 2014 to 2020. Women with diabetes had a significantly higher prevalence of all the pain sites analyzed than men with diabetes. After matching by sex and age, the prevalence of CNP (26.0% vs. 21.1%; p < 0.001), CLBP (31.2% vs. 25.0%; p < 0.001), and MFH (7.7% vs. 6.5%; p = 0.028) was higher for people with diabetes than for those without diabetes. Self-reported mental disease was independently associated with reporting the three pain sites analyzed in people with diabetes. (4) Conclusions: The prevalence of CNP, CLBP, and MFH has remained stable over time. Remarkable sex differences were found, with a higher prevalence among women than men with diabetes. Diabetes was associated with reporting in all the pain sites analyzed. Self-reported mental disease was associated with reporting CNP, CLBP, and MFH.

Prevalence and biopsychosocial factors associated with chronic low back pain in urban and rural communities in Western Africa: a population-based door-to-door survey in Benin

PURPOSE

This study aimed to assess the prevalence of chronic low back pain (CLBP) and related biopsychosocial factors in urban and rural communities in Benin.

METHODS

This is a population-based observational cross-sectional survey. An interviewer-administered electronic questionnaire was used to collect information on demographic, socio-economic, behavioral, and psychological factors relating to CLBP risk factors and medical history of participants. The numeric pain rating scale and the Beck Depression Inventory were used to assess pain intensity and the level of depression, respectively. Bivariate analyses were performed to investigate the association between sociodemographic, behavioral, and psychological factors and CLBP. Sequential multiple regression analyses were subsequently performed to predict the occurrence of CLBP.

RESULTS

A total of 4320 participants, with a mean age ± SD of 32.9 ± 13.1 years, of which 40.7% were females and 50.1% from an urban area, were enrolled in the study. We found a global prevalence rate of CLBP of 35.5% [95% CI 34.1-36.9%]. The prevalence in urban areas was 30.68% [95% CI 28.9-32.8%]) while 40.2% was found in rural areas [95% CI 38.1-42.2%]). Age (p < 0.001), level of education (p = 0.046), marital status (p < 0.001), working status (p < 0.003), tobacco use (p < 0.016) and regular physical activity (p < 0.011) were associated with CLBP. In urban areas, only the level of education was able to predict the prevalence of CLBP (R2 = 61%). In rural areas, CLBP was predicted by age, marital and working status (R2 = 89%).

CONCLUSIONS

This study showed a high prevalence of CLBP among urban and rural communities in Benin. Age, level of education, marital status, and working status were significantly associated with CLBP in Benin.

Evaluation of Physical Therapy Interventions for Improving Musculoskeletal Pain and Quality of Life in Older Adults

Background: The ageing process may lead to functional limitations, musculoskeletal pain, and worsened quality of life. The aim of this paper is to evaluate two physical therapy interventions for reducing musculoskeletal pain and improving quality of life in older adults. Methods: A cohort study was carried out with older people (60−75 years old). The Geriatric Physical Therapy group (n = 70) received massage therapy, therapeutic exercise, and therapeutic education program for 5 weeks; the Standardized Therapeutic Exercise group (n = 140) received a standardized therapeutic exercise and therapeutic education program for 3 weeks. Health-related quality of life (SF-36v2) and musculoskeletal pain intensity (VAS) were collected at baseline (A0), post-intervention (A1), and 12 weeks after baseline (A2). Results: There was pain intensity reduction in both groups (p < 0.05) and health-related quality of life improvement, except for Emotional Role (p = 0.34); Physical Function (p = 0.07), Bodily Pain (p = 0.02), and General Health (p = 0.09). At A2 there was a difference (p < 0.05) for neck pain in favor of the Geriatric Physical Therapy Group. Conclusions: Within the limitations of the study, it was possible to conclude that both physical therapy interventions showed a positive effect for reducing non-specific neck pain and low back pain in older adults, which may contribute to health-related quality of life improvement.

Spinal manipulative therapy in older adults with chronic low back pain: an individual participant data meta-analysis

PURPOSE

Many systematic reviews have reported on the effectiveness of spinal manipulative therapy (SMT) for low back pain (LBP) in adults. Much less is known about the older population regarding the effects of SMT.

OBJECTIVE

To assess the effects of SMT on pain and function in older adults with chronic LBP in an individual participant data (IPD) meta-analysis.

SETTING

Electronic databases from 2000 until June 2020, and reference lists of eligible trials and related reviews.

DESIGN AND SUBJECTS

Randomized controlled trials (RCTs) which examined the effects of SMT in adults with chronic LBP compared to interventions recommended in international LBP guidelines.

METHODS

Authors of trials eligible for our IPD meta-analysis were contacted to share data. Two review authors conducted a risk of bias assessment. Primary results were examined in a one-stage mixed model, and a two-stage analysis was conducted in order to confirm findings.

MAIN OUTCOMES AND MEASURES

Pain and functional status examined at 4, 13, 26, and 52 weeks.

RESULTS

10 studies were retrieved, including 786 individuals, of which 261 were between 65 and 91 years of age. There is moderate-quality evidence that SMT results in similar outcomes at 4 weeks (pain: mean difference [MD] - 2.56, 95% confidence interval [CI] - 5.78 to 0.66; functional status: standardized mean difference [SMD] - 0.18, 95% CI - 0.41 to 0.05). Second-stage and sensitivity analysis confirmed these findings.

CONCLUSION

SMT provides similar outcomes to recommended interventions for pain and functional status in the older adult with chronic LBP. SMT should be considered a treatment for this patient population.

Effects of core stability training on older women with low back pain: a randomized controlled trial

Background

Studies have demonstrated that elderly people with low back pain (LBP) may have poor postural control compared to healthy older adults. Poor postural control is associated with poor balance performance and a high risk of serious falls. A variety of training strategies are proposed for LBP therapy, particularly core stabilization training. But this treatment for older people with LBP remains unclear.

Methods

31 participants were randomly placed in a core stability training group (TG, n = 15) and a control group (CG, n = 16). The participants in the training group were required to complete 4 sets of core stability training and conventional physiotherapy 4 times per week for 4 weeks, whereas the participants in the control group only completed physiotherapy 4 times per week for 4 weeks. Ultrasound imaging was used to measure transverse abdominal muscle (TrA) thickness before and after the intervention. A 10-cm visual analog scale (VAS), the Oswestry Disability Index (ODI), and mobility functions were applied before and after the intervention. Data are reported as the median and range and were compared using two-way repeated-measures ANOVA,t-tests and chi-squared tests. P < 0.05 was considered significant in all statistical tests.

Results

After intervention, there was a statistically significant difference in scores in the intervention group, especially for VAS, ODI, timed up-and-go,10-m walking and the four-square step test. TrA thickness was increased after core stability training, which was not observed in the control group.

Conclusion

Core stability training is an effective intervention for older women with LBP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11556-022-00289-x.

Decreasing prevalence of chronic back pain in Catalonia. Analysis of the Catalan Health Survey

OBJECTIVES

Chronic back pain is one of the main health problems reported by the adult population and its prevalence is influenced by different sociodemographic, work and lifestyle-related factors. The aim of this study was to describe the trend in the lifetime prevalence of chronic back pain in the adult Catalan population between 2011 and 2018 and its associated factors.

STUDY DESIGN

Cross-sectional study. Secondary analysis of a health survey.

METHODS

Trend in lifetime prevalence of chronic back pain by age and sex groups was estimated from the Catalan Health Survey. Association of chronic back pain with sex, age, health status, lifestyle factors, comorbidities, socio-economic and work-related variables was analysed.

RESULTS

A total of 31,823 people were interviewed between 2011 and 2018. The prevalence of chronic back pain decreased from 29.7% to 24.2% between 2011-2014 and 2015-2018 in the total population with higher prevalence and a greater difference in women (35%-28.50%) than in men (24.2%-19.7%). Factors associated with higher prevalence of chronic back pain were female sex, older age, poor health status, smoking, alcohol consumption, insufficient physical activity, overweight or obesity, mental health problems, lower educational level or social class, dissatisfaction at workplace, poor social support and family financial problems.

CONCLUSIONS

The analysis shows a decreasing prevalence of chronic back pain from 2011 to 2018 in the adult population of Catalonia in all age groups and more significantly in women. An improvement of healthy lifestyle habits, social and occupational determinants, could have reduced the burden of chronic back pain in our community.

Influence of Spinal Movements Associated with Physical Evaluation on Muscle Mechanical Properties of the Lumbar Paraspinal in Subjects with Acute Low Back Pain

This research aimed to identify changes in muscle mechanical properties (MMPs) when a standardized sequence of movements is performed and to determine the influence of acute low back pain (LBP) and age on the MMPs. Socio-demographic, clinical variables and MMPs were collected in 33 patients with LBP and 33 healthy controls. A 2 × 2 × 2 (group × age × time) analysis of variance (ANOVA) mixed model was used to determine the effect of the study factors on the different MMPs. There were no significant triple interactions. After the movements, tone and stiffness increased 0.37 Hz and 22.75 N/m, respectively, in subjects <35 years, independent of their clinical status. Relaxation showed differences by age in healthy subjects and creep in LBP subjects. Furthermore, elasticity was higher in <35 years (p < 0.001) without the influence of any other factor. In conclusion, sequenced movements can modify tone and stiffness as a function of age, while age-associated changes in viscoelastic characteristics depends on pain but not on movements. The MMPs should be assessed, not only at the beginning of the physical examination at rest, but also along the patient's follow-up, depending on their pain and age, in a clinical setting.

[Pain and cervical disability among public workers who use data visualization display terminals]

Work-related neck/shoulder disorders are considered an important health issue. This study is aimed at establishing the pain and cervical disability patterns of workers with visual display terminals, as well as at determining the factors that mostly affect the onset of a new episode of back pain. A descriptive, correlational study was carried out on a sample of 88 workers who use visual display terminals, of the Ministry of Health (Xunta de Galicia). The workers completed the following questionnaires: "Neck Disability Index Scale," "Visual Analog Scale," "12-item Short Form Health Survey," and an individual postural analysis was conducted. For the comparative analysis, the Student's t-test, and the Mann-Whitney U test were performed. A binary logistic regression analysis was used to extract a predictive model of a cervical pain episode, and 58% reported cervical pain. There were no differences between men and women. The variables that best predict the onset of a new episode of pain are the level of disability, and the quality of physical life. Study results indicate that a worker who uses visual display terminals, with high levels of cervical disability and low values of physical quality of life, is more likely to suffer an episode of back pain.

The prevalence and risk factors of chronic low back pain among adults in KwaZulu-Natal, South Africa: an observational cross-sectional hospital-based study

Background

Globally, chronic low back pain (CLBP) is the leading cause of disability associated with economic costs. However, it has received little attention in low-and-middle-income countries. This study estimated the prevalence and risk factors of CLBP among adults presenting at selected hospitals in KwaZulu-Natal.

Methodology

This cross-sectional study was conducted among adults aged ≥18 years who attended the selected hospitals in KwaZulu-Natal during the study period. A self-administered questionnaire was used to collect data on socio-demographic, work-related factors, and information about CLBP. The SPSS version 24.0 (IBM SPSS Inc) was used for data analysis. Descriptive statistics were used for demographic characteristics of participants. CLBP risk factors were assessed using multivariate logistic regression analysis. A p-value of ≤0.05 was deemed statistically significant.

Results

A total of 678 adults participated in this study. The overall prevalence of CLBP was 18.1% (95% CI: 15.3 – 21.3) with females having a higher prevalence than males, 19.8% (95% CI: 16.0 – 24.1) and 15.85% (95% CI: 11.8 – 20.6), respectively. Using multivariate regression analysis, the following risk factors were identified: overweight (aOR: 3.7, 95% CI: 1.1 – 12.3, p = 0.032), no formal education (aOR: 6.1, 95% CI: 2.1 – 18.1, p = 0.001), lack of regular physical exercises (aOR: 2.2, 95% CI: 1.0 – 4.8, p = 0.044), smoking 1 to 10 (aOR: 4.5, 95% CI: 2.0 – 10.2, p < 0.001) and more than 11 cigarettes per day (aOR: 25.3, 95% CI: 10.4 – 61.2, p < 0.001), occasional and frequent consumption of alcohol, aOR: 2.5, 95% CI: 1.1 – 5.9, p < 0.001 and aOR: 11.3, 95% CI: 4.9 – 25.8, p < 0.001, respectively, a sedentary lifestyle (aOR: 31.8, 95% CI: 11.2 – 90.2, p < 0.001), manual work (aOR: 26.2, 95% CI: 10.1 – 68.4, p < 0.001) and a stooped sitting posture (aOR: 6.0, 95% CI: 2.0 – 17.6, p = 0.001).

Conclusion

This study concluded that the prevalence of CLBP in KwaZulu-Natal is higher than in other regions, and that it is predicted by a lack of formal education, overweight, lack of regular physical exercises, smoking, alcohol consumption, sedentary lifestyle, manual work, and a stooped posture.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04790-9.

Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial

BACKGROUND

This study aimed to compare the effectiveness of cervical lateral glide (CLG) added to median nerve neural mobilization (MNNM) in patients with neck pain (NP).

METHODS

A single-blinded randomized controlled clinical trial was carried out in a Pain Management Unit from a Hospital. A total sample of 72 patients with NP was recruited from a hospital. Patients were randomized to receive isolated CLG (n = 36) or CLG + MNNM (n = 36). Bilateral elbow extension range of motion (ROM) on upper limb neurodynamic test 1 (ULNT1), bilateral pressure pain thresholds (PPT) on the median nerve at elbow joint, C6 zygapophyseal joint and tibialis anterior, Visual analogue scale (VAS), body chart distribution of pain, active cervical ROM (CROM), Neck Disability Index (NDI), and Tampa Scale of Kinesiophobia (TSK-11) were measured at baseline as well as immediately, 15 days, and 1 month after treatment.

RESULTS

There were no statistically significant interactions (p > 0.05) between treatment and time for median nerve mechanosensitivity outcomes, pain intensity, symptom distribution, and PPT of the widespread pain assessment, as well as cervical function, and kinesiophobia.

CONCLUSIONS

MNNM gave no additional benefit to CLG in patients with NP regarding pain intensity, symptom distribution, mechanosensitivity, functionality, and kinesiophobia. Only two treatment sessions and the short follow-up are important issues, therefore, justifying further studies to answer the research question with better methodology.

Paravertebral Muscle Mechanical Properties in Patients with Axial Spondyloarthritis or Low Back Pain: A Case-Control Study

Different musculoskeletal disorders are a source of pain in the spinal region; most of them can be divided into mechanical, such as low back pain (LBP), or inflammatory origins, as is the case of axial spondyloarthritis (axSpA). Nevertheless, insufficient information is available about the muscle negative consequences of these conditions. Thus, the objective of this study was to identify whether mechanical muscle properties (MMPs) of cervical and lumbar muscles are different between patients with axSpA, subacute LBP (sLBP), and healthy controls. Furthermore, we aimed identify whether MMPs were related to sociodemographic and clinical variables in various study groups. The MMPs, sociodemographic, and clinical variables were obtained in 43 patients with axSpA, 43 subjects with sLBP, and 43 healthy controls. One-way ANOVAs and ROC curves were applied to identify whether the MMPs could differentiate between the study groups. Intra-group Pearson r coefficients to test the associations between MMPs and the rest of the variables were calculated. The results showed that axSpA subjects have a higher tone and stiffness and a lower relaxation and creep than sLBP and healthy ones (p < 0.05). All lumbar and cervical MMPs, except for decrement, could correctly classify axSpA and healthy subjects and axSpA and sLBP patients (in both cases, Area Under the Curve > 0.8). However, no MMP could differentiate between sLBP and healthy subjects. Each group had a different pattern of bivariate correlations between MMPs and sociodemographic and clinical data, with a worse state and progression of the axSpA group associated with a higher tone and stiffness in both spinal regions. This study supports that MMPs are different and show different patterns of correlations depending on the type of spinal pain.

Low back pain prevalence and associated factors in nurses from Brazilian primary health units

BACKGROUND

Primary health unit (PHU) nursing work is different when compared to hospital environment. Although low back pain (LBP) literature presents studies conducted in hospital nursing personnel, there is a lack of studies in PHU nurses.

OBJECTIVE

This study aimed to measure the prevalence of LBP in PHU nursing personnel in the city of Pelotas, Brazil.

METHODS

Sociodemographic (age, gender, number of children, skin color, income and marital status), occupational (PHU type, formal education, professional experience, weekly workload, extra work activity, workload perception), nutritional (BMI), health (self-perceived health, smoking, sleep quality and minor psychiatric disorders, PHU physical structure perception) and behavioral (leisure-time physical activity) characteristics were assessed. LBP was defined as pain or discomfort between the last rib and gluteal fold. Poisson regression was used to evaluate the relationship among LBP and covariates.

RESULTS

LBP prevalence was 65.2%. Chronic (12 weeks) and acute (7 days) LBP prevalence were 22.4%and 53.4%, respectively. LBP was associated with obesity (PR 1.39 95%CI 1.01-1.92) and poor self-perceived health (PR 2.77 95%CI 1.32-5.80).

CONCLUSIONS

Prevalence of LBP in PHU nursing personnel is high and similar to hospital nurses. Individual characteristics such as body mass and health perception were associated with LBP.

Prevalence, Incidence, and Factors Associated With Non-Specific Chronic Low Back Pain in Community-Dwelling Older Adults Aged 60 Years and Older: A Systematic Review and Meta-Analysis

Chronic low back pain (CLBP) is common among older adults. This systematic review aimed to summarize: (1) the prevalence and incidence of CLBP in older adults, and (2) demographic, psychological, and clinical factors positively/negatively associated with prevalence/incidence of CLBP among older adults. Four databases were searched to identify relevant publications. Ten studies (31,080 older adults) were included after being screened by 5 independent reviewers using predetermined criteria. The methodological quality of these studies was evaluated by standardized tools. The quality of evidence for all factors were appraised by modified GRADE for cohort studies. Twenty-eight and 1 factors were associated with a higher prevalence and a lower 5-year cumulative incidence of CLBP, respectively. No prognostic factor was identified. There was very limited to limited evidence that females, obesity, anxiety, depression, mental disorders, self-expectation of recovery, self-perceived health status, lifestyle (smoking, daily fluoride consumption), previous falls or lower body injury, retirement/disability due to ill health, family history of body pain, comorbidity (knee osteoarthritis, or chronic obstructive pulmonary disease with/without hypertension), weak abdominal muscles, leg pain, leg pain intensity, widespread pain, pain interference on functioning, use of pain medication, occupational exposure (driving for >20 years, or jobs involving bending/twisting for >10 years), disc space narrowing and severe facet osteoarthritis were significantly related to a higher prevalence of CLBP in older adults. However, very limited evidence suggested that intermediate level of leisure-time physical activity was associated with a lower prevalence of CLBP in older adults. Given the aging population and limited information regarding risk factors for CLBP in older adults, future high-quality prospective studies should identify relevant risk factors to help develop proper preventive and treatment strategies. PERSPECTIVE: Despite the high prevalence of non-specific chronic low back pain among older adults, there is only very limited to limited evidence regarding factors associated with a higher prevalence of chronic low back pain in this population. Given the aging population, high-quality prospective studies are warranted to address this gap.

Static and Dynamic Pain Sensitivity in Adults With Persistent Low Back Pain: Comparison to Healthy Controls and Associations With Movement-evoked Pain Versus Traditional Clinical Pain Measures

OBJECTIVES

Despite its impact, individual factors associated with persistent low back pain (LBP) remain poorly understood. This study investigated static and dynamic pain sensitivity in adults with persistent LBP versus pain-free controls; and investigated associations between pain sensitivity and 3 clinical pain measures: recalled, resting, and movement-evoked pain (MEP).

MATERIALS AND METHODS

A lifespan sample of 60 adults with persistent LBP and 30 age-matched/sex-matched controls completed 4 laboratory sessions. Static pain sensitivity (pressure pain threshold [PPT], heat pain threshold) and dynamic pain sensitivity (heat pain aftersensations [AS], temporal summation [TS] of second heat pain) were measured. Demographic and clinical factors collected were education, global cognition, and perceived health. Resting and recalled pain were measured via questionnaire, and MEP via the Back Performance Scale.

RESULTS

LBP participants demonstrated lower PPT remotely (hand; F1,84=5.34, P=0.024) and locally (low back; F1,84=9.55, P=0.003) and also had higher AS (F1,84=6.01, P=0.016). Neither static nor dynamic pain sensitivity were associated with recalled pain (P>0.05). However, static pain sensitivity (local PPT) explained an additional 9% variance in resting pain, while dynamic pain sensitivity (AS, TS) explained an additional 10% to 12% variance in MEP.

DISCUSSION

This study characterized pain sensitivity measures among individuals with persistent LBP and suggests static pain sensitivity plays a larger role in resting pain while dynamic pain sensitivity plays a larger role in MEP. Future studies will confirm these relationships and elucidate the extent to which changes in static or dynamic pain sensitivity predict or mediate clinical pain among adults with persistent LBP.

Female Gender Is Associated with a Higher Prevalence of Chronic Neck Pain, Chronic Low Back Pain, and Migraine: Results of the Spanish National Health Survey, 2017

OBJECTIVES

To assess the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine headache (MH) in the Spanish population and to identify sociodemographic and health-related variables associated with CNP, CLBP, and MH.

DESIGN

Observational study.

SETTING

Spain.

SUBJECTS

A total of 22,511 persons 18 years of age or older (10,304 males and 12,207 females) who participated in the 2017 Spanish National Health Survey.

METHODS

Stratified three-stage sampling was applied. CNP, CLBP, and MH were the dependent variables. The analysis was conducted separately by gender. Sociodemographic features, self-perceived health status, lifestyle habits, comorbidities, and pain features were analyzed by using logistic regression models.

RESULTS

Females reported a higher prevalence of CNP, CLBP, and MH (P < 0.001) than males. For both sexes, anxiety and/or depression and poor self-rated health were associated with a significantly increased prevalence of CNP, CLBP, and MH. For CNP and CLBP, the identified associated factors were older age and limitations to usual activity. For CNP and MH, the most common associated factor was comorbid respiratory disease.

CONCLUSIONS

Our study identified several factors associated with CNP, CLBP, and MH in Spanish female and male adults, with potential implications for health care providers.

Efficacy and tolerability of tapentadol for the treatment of chronic low back pain in elderly patients

BACKGROUND

Chronic low back pain (CLBP) is a highly prevalent and disabling condition in the elderly, and yet it is undertreated and understudied in this patient population. Tapentadol is a central analgesic with an improved tolerability profile that may be particularly beneficial to the elderly CLBP.

METHODS

We performed an observational retrospective study to comparatively assess the efficacy and tolerability of tapentadol in young and elderly patients with severe CLBP. Sixtyfive young patients (< 65 years) and 87 elderly patients (≥ 65 years) were titrated on tapentadol extended release to their optimal dose (25-250 mg bid) over 1 month and, then, maintained at that dose for 3 months. The primary endpoint were changes from baseline in 24-h pain intensity on a 0-10 Numerical Rating Scale (NRS) at month-4 of treatment (titration plus maintenance periods). Patients were assessed for several efficacy and tolerability outcomes using a battery of scales and tests for neuropathic pain intensity, quality of life and sleep, and cognitive and gastrointestinal functions.

RESULTS

At pretreatment, young and elderly patients had similar pain intensities with younger patients presenting with more intense depressive and neuropathic pain symptoms, and lesser comorbidities and durations of pain (P < 0.05). Thirty-eight patients discontinued treatment because of adverse events occurring mostly during titration. Treatment with tapentadol was associated with comparable and clinically meaningful pain reductions in 24-h NRS from baseline to treatment month-4 both in young and elderly patients (- 5.3 ± 1.4 and - 4.8 ± 2.1; P < 0.01); a 50% pain relief was achieved in 66% and 58% of young and elderly patients. The percentage of patients with a neuropathic component decreased similarly in young and elderly patients (from 38 to 0% and from 19 to 3%; P < 0.01). Quality of life and sleep improved. The performances in global cognition and sustained attention tasks remained stable or improved across all age group.

CONCLUSIONS

These findings indicate that tapentadol extended release maintains efficacy and good tolerability in CLBP patients with advancing age.

How cognitive loads modulate the postural control of older women with low back pain?

BACKGROUND

The capacity of postural control is a key factor related to falling in older people, particularly in older women with low back pain (LBP). Cognitive involvement in postural control increases with age. However, most scholars have not considered different difficulty levels of cognitive loads when exploring the effects of cognition on postural control in older patients with LBP. The present study is to investigate how different levels of cognitive loads modulate postural control in older women with LBP.

METHODS

This was a cross-sectional study. Twenty older women with LBP were recruited into the LBP group, and 20 healthy older women without the history of LBP were recruited into the healthy control group. Balance parameters were computed to quantify postural control. All participants underwent the balance test, which required the participant to maintain stability during standing on a force platform with or without a concurrent cognitive task. The balance test included three levels of difficulties of posture tasks (eyes-open vs. eyes-closed vs. one-leg stance) and three cognitive tasks (without cognitive task vs. auditory arithmetic task vs. serial-7 s arithmetic task).

RESULTS

A repeated-measure analysis of variance (3 postural tasks × 3 congnitive tasks× 2 groups) testing the effects of the different congnitive task levels on the performance in different postural conditions. Older women with LBP had worse postural control (as reflected by larger center of pressure (COP) parameters) than control group regardless of postural or cognitive difficulties. Compared with the single task, the COP parameters of participants with LBP were larger during dual tasks, even though the difficulty level of the cognitive task was low. Larger COP parameters were shown only if the difficulty level of the cognitive task was high in control group. Correlations between sway area/sway length and the number of falls were significant in dual tasks.

CONCLUSION

Our findings shed light on how cognitive loads modulate postural control for older women with LBP. Compared with control group, cognitive loads showed more disturbing effects on postural control in older women with LBP, which was associated with falling.

[Therapeutic exercise as treatment for spinal chronic pain: systematic review of randomized clinical trials]

OBJECTIVE

The objective of the present review was to analyze and compare the effectiveness of different types of therapeutic exercise in people with chronic spinal pain.

METHODS

Data search was conducted using the electronic database MEDLINE. Randomized clinical trials, conducted in patients between 18 and 65 years old with chronic pain in the spine region, were included.

RESULTS

Two independent reviewers performed the analysis of methodological quality using the PEDro scale, with 13 studies finally selected. The different types of therapeutic exercise had significant effects on pain reduction, decrease of disability and improvement of the quality of life of the patients.

CONCLUSIONS

The results show that there is no modality of therapeutic exercise superior to others. The combination of different therapeutic exercise modalities could be a complete tool for the management of chronic pain in the spine.

Trends in disease-free life expectancy at age 65 in Spain: Diverging patterns by sex, region and disease

Life expectancy in Spain is among the highest in the world. Nevertheless, we do not know if improvements in health conditions at older ages have followed postponements of death. Previous studies in Spain show a stable trend in years lived in ill health in the past. In this paper we investigate changes between 2006, 2012 and 2017 in life expectancy with and without disease at age 65 in Spain and, for the first time, in Spanish regions, which have autonomous powers of health planning, public health and healthcare. Results show that, at the country level, disease-free life expectancy reduced between 2006 and 2017 in Spain. This was explained by an expansion of most diseases except for some cardiovascular and respiratory chronic conditions. However, at the regional level the evolution was different, especially regarding each disease and sex. First, regional differences reduced between 2006 and 2012 but largely widened in 2017, suggesting that not all regions had the same ability to recover after the 2008 financial crisis that caused government cuts to health services. Second, regional analysis also highlighted diverging trends by sex. While men experienced expansion of morbidity in most regions, women experienced a compression in about half of them, ending up with women showing higher disease-free life expectancies than men in 9 out of the 17 regions considered. This study, then, calls attention to the importance of focusing the analysis of health surveillance to more disaggregated levels, more in accordance with the level of health management, as regional trends showed heterogeneity in the prevalence of diseases and different progresses in the relationship between sexes.

Gender Differences in the Prevalence and Characteristics of Pain in Spain: Report from a Population-Based Study

OBJECTIVE

To assess the prevalence and characteristics of chronic neck pain, chronic low back pain, and migraine or frequent headaches among Spanish adults in 2014 according to gender, to identify predictors for each of these types of pains, and to compare the prevalence with those found in 2009.

DESIGN

Cross-sectional study.

SETTING

Spain.

METHODS

We used data collected from the 2014 European Health Interview Survey (N = 22,842). Sociodemographic features, self-rated health status, lifestyle habits, comorbid conditions, pain characteristics, and self-reported use of medications were analyzed.

RESULTS

The prevalence of all types of pain was significantly higher among women than men. For chronic neck pain, the figures were 25.68% vs 12.54%, for chronic low back pain, 27.03% vs 18.83%, and for migraine or frequent headaches, 15.93% vs 6.74%, in women and men, respectively. Predictors of these types of pain included female gender, advanced age, poor self-rated health, psychological distress, comorbidities, and obesity. The prevalence of neck pain and low back pain increased from 2009 to 2014 for both sexes, and the prevalence of migraine or frequent headaches remained stable over time.

CONCLUSIONS

The prevalence and intensity of all the forms of chronic pain were higher among women. Women experiencing pain used prescribed medications for pain, anxiety, and/or depression and sleeping pills more than men. The prevalence of chronic neck and low back has increased in the last five years in Spain, and the prevalence of migraine or frequent headaches has remained stable.

Is There an Association between Diabetes and Neck and Back Pain? Results of a Case-Control Study

We aimed to assess if subjects with diabetes exhibit higher prevalence of chronic back pain than age-sex-province of residence-matched non-diabetic controls. We also aimed to identify predictors for chronic neck pain (CNP) or chronic low back pain (CLBP) among subjects with diabetes. A case control study was conducted using data obtained from the Spanish National Health Survey 2017. Multivariable conditional and unconditional logistic regression models were constructed. A total of 2095 diabetes sufferers and 2095 non-diabetic matched controls were analyzed. The prevalence of CNP and CLBP was 27.3% and 34.8%, respectively, in diabetes sufferers and 22.1% and 29.0% in non-diabetes controls (both, p < 0.001). After multivariable analysis, the ORs showed significantly higher adjusted risk of CNP (OR 1.34; 95% CI 1.19–1.51) and CLBP (OR 1.19, 95% CI 1.09–1.31) in diabetes cases. Diabetes sufferers with CNP or CLBP showed higher use of pain medication and higher prevalence of migraine/frequent headache than controls. Female sex, worse self-rated health and use of pain medication were predictors for CNP and CLBP in subjects with diabetes. CNP and CLBP are significantly more prevalent in diabetes sufferers than in controls. Current results can help to design better preventive and educational strategies for these highly prevalent and burdensome pains among diabetic patients.

Efficacy of conservative therapy in older people with nonspecific low back pain: A systematic review with meta-analysis and GRADE recommendations

PURPOSE

This systematic review aimed to investigate the effectiveness of conservative therapy in older people with nonspecific low back pain.

MATERIALS AND METHODS

Searches were conducted on Medline, Amed, Embase, Cochrane, Psycinfo and Pedro databases up to 2020. Risk of bias were assessed using the 0-10 PEDro scale. Weighted mean differences (WMDs) or mean differences (MDs) with 95 % confidence intervals (CIs) were reported for each conservative therapy, and strength of the current evidence was assessed using the GRADE approach.

RESULTS

Eleven original trials were included investigating effects on disability, pain, coping, quality of life, strength, balance, depression, falls, sleep quality, mobility, body mass index, percentage body fat, trunk muscle mass and waist-to-hip ratio. Moderate quality evidence showed short-term effects of trigger point acupuncture on disability (WMD = 5.0 points [95 % CI 3.5-6.4] on a 25-point scale) and pain (WMD = 35.9 points [95 % CI 22.2-49.7] on a 101-point scale), and of exercise on disability (WMD = 1.7 points [95 % CI 0.3-3.0]) when compared with control (placebo, sham, waiting list or no intervention). Moderate quality evidence showed no short-term effect of exercise on coping (95 % CI -5.0 to 14.6). Moreover, evidence for other important outcomes in older people is scarce and we did not find any trial investigating pharmacological therapies.

CONCLUSION

Findings support partially exercise and trigger point acupuncture to improve disability and/or pain. Future trials with appropriate sample sizes are likely to impact on the estimates and need to clarify medium- and long-term effects.

Influence of Psychosocial and Sociodemographic Variables on Sickness Leave and Disability in Patients with Work-Related Neck and Low Back Pain

The purpose of this study was to describe the association between psychosocial factors in patients with work-related neck or low back pain (n = 129), in order to study sickness leave, its duration, the disability reported, and to analyze the relationship of these factors with different sociodemographic variables. This was a descriptive cross-sectional study. Data on kinesiophobia, catastrophizing, disability, and pain were gathered. Sociodemographic variables analyzed included sex, age, occupational, and educational level. Other data such as location of pain, sick leave status and duration of sickness absence were also collected. Educational level (p = 0.001), occupational level (p < 0.001), and kinesiophobia (p < 0.001) were found to be associated with sickness leave; kinesiophobia (b = 1.47, p = 0.002, r = 0.35) and catastrophizing (b = 0.72, p = 0.012, r = 0.28) were associated with the duration of sickness leave. Educational level (p = 0.021), kinesiophobia (b = 1.69, p < 0.000, r = 0.505), catastrophizing (b = 0.76, p < 0.000, r = 0.372), and intensity of pain (b = 4.36, p < 0.000, r = 0.334) were associated with the degree of disability. In the context of occupational insurance providers, educational and occupational factors, as well as kinesiophobia and catastrophizing, may have an influence on sickness leave, its duration and the degree of disability reported.

Effects of Virtual Reality versus Exercise on Pain, Functional, Somatosensory and Psychosocial Outcomes in Patients with Non-specific Chronic Neck Pain: A Randomized Clinical Trial

Background: Virtual reality (VR) applied to patients with neck pain is a promising intervention to produce positive effects when used alone or combined with exercise. Therefore, the objective of this manuscript is to compare the effects of VR versus exercise treatment on pain intensity, conditioned pain modulation (CPM), temporal summation (TS) and functional and somatosensory outcomes in patients with non-specific chronic neck pain (NS-CNP). Methods: A single-blinded, randomized clinical trial was carried out. A total sample of 44 patients with NS-CNP was randomized into a VR treatment group or neck exercises group. The intervention consisted of two treatment sessions per week, for four weeks and eight sessions. Four measurement moments (at baseline, immediately, 1 month, and 3 months after intervention) were considered. Pain intensity, CPM, TS, functional and somatosensory outcomes were measured. Results: Statistically significant differences were revealed for time factor (F = 16.40, p < 0.01, ηp2 = 0.28) and group*time interaction for kinesiophobia (F = 3.89, p = 0.01, ηp2 = 0.08) showing post-hoc differences in favor of the VR group at 3 months (p < 0.05, d = 0.65). Significant effects were shown for time factor (p < 0.05) but not for the group*time interaction (p > 0.05) for pain intensity, rotation range of motion (ROM), Neck Disability Index, pain catastrophizing, fear-avoidance beliefs, left side pressure pain threshold (PPT) and anxiety. Statistically significant differences were not found for time factor (p > 0.05) and neither in group*time interaction (p > 0.05) for CPM, TS, right side PPT, flexo-extension and lateral-flexion ROM. Conclusions: Kinesiophobia was the only outcome that showed differences between VR and exercise at 3 months. Nevertheless, pain intensity, CPM, TS, ROM, neck disability, pain catastrophizing, fear-avoidance beliefs, PPT and anxiety did not show differences between both interventions.

Neck Pain- and Unsteadiness-Inducing Activities and their Relationship to the Presence, Intensity, Frequency, and Disability of Headaches

(1) Background: Headache is a significant public health problem. Despite the association between headache and neck pain, little is known about the relationships among specific activities that generate neck pain and headache. The aim of this study was to identify the specific activities that result in neck pain and unsteadiness, and determine how they are linked to headache in university students. (2) Methods: One hundred and six patients with physician-diagnosed headache and 92 healthy university students completed surveys assessing demographics; the presence, frequency, intensity, and disability of headaches; and activities generating neck pain and unsteadiness. (3) Results: The presence of headache was related to female gender (p = 0.001), neck pain when reading or watching television (p = 0.024), and unsteadiness when moving the head (p = 0.005). Headache-related disability was associated with intensity of neck pain (p < 0.001), neck pain when reading or watching television (p = 0.033), and stumbling (p < 0.001). Headache frequency was related to smoking (p = 0.004), the duration of neck pain-associated symptoms (p = 0.047), and neck pain when driving (p = 0.039). Intensity of headache was associated with female gender (p = 0.002), smoking (p = 0.013), and neck pain-related sleep alterations (p = 0.024). (4) Conclusions: Female gender, smoking, neck pain, and unsteadiness when moving the head are factors related to headache in university students.

Lower back pain at workplace: prevalence and risk factors

Objective — analysis of lower back pain (LBP) prevalence and risk factors for its development in employees with different conditions at their workplace, depending on their age, length of service, occupational factors, and physical activity. Material and Methods — As a result of a simultaneous cross-sectional study, 3300 employees with different conditions at their workplace were examined. To study the relationships between LBP prevalence and risk factors, we used the results of employees’ survey and physical examination, along with the data on their physical activity and working conditions. Results — The workplace posture was the most common production-related risk factor for developing LBP. The second most common risk factor was the weight of the load being lifted and carried, followed by general vibration at a workplace. The least significant factor was a bending motion. According to our data, LBP prevalence in all observation groups was increasing with both age and length of employment. Over 50% of those working in hazardous conditions at the age of 50 yo and higher had LBP. Low physical activity at a workplace led to a statistically significant increase in the chances of LBP emergence. Conclusion — In employees without exposure to harmful risk factors in the form of physical exertion and general vibration, the prevalence of LBP was significantly lower than in workers in harmful working conditions. The combined effect of static and dynamic physical activities at a workplace had a more pronounced negative impact on workers’ health. Low physical activity was a significant risk factor for LBP development.

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

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.

Intra-rater and inter-rater reliability of cervical active range of movement in young asymptomatic adults using inertial sensors

Objectives: Current literature is scarce about the use of an inertial sensor to measure cervical active range of motion (aROM). The objective of the present study is to determine inter- and intra-reliability in the measurement of cervical aROM using inertial sensors in asymptomatic individuals.Materials and methods: Twenty asymptomatic individuals participated in the study. Two different physiotherapists measured each participant for cervical aROM (6 movements). The sequence of movements and the explanations given were standardized. The rater's order of measurement was randomized.Results: For the intra-rater results, the intraclass correlation coefficient (ICC) values for all cervical movements were good for Rater A (ICC >0.90) and Rater B (ICC >0.90). For the inter-rater results, the ICC values were above 0.75 for all movements, indicating a good level of reliability. Also, values obtained in SEM, MDC₉₀ and LOA indicate good agreement.Conclusion: The data obtained in this study suggest that inertial sensors can be used in clinics due to their high intra- and inter-rater ICC (>0.80). Also, its low economic cost, easy handling, and various utilities make this tool a useful alternative in the measurement of cervical aROM.

Visceral Origin: An Underestimated Source of Neck Pain. A Systematic Scoping Review

The diagnosis of neck pain is challenging. Many visceral disorders are known to cause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis. However, the absence of suspicion of any cause impedes one from establishing that specific aetiology as the final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematic search of trials about neck pain was carried out to evaluate their selection criteria. The search yielded 309 eligible articles, which were screened by two independent reviewers. The PEDro scale score was used to assess the methodological quality of the studies. The following information was retrieved: number of authors affiliated to a clinical or non-clinical institution, number of citations in the Web of Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most cited trials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartile journals of the Journal Citation Reports, were selected. Females represented 67.5% of participants. A single study was of poor methodological quality (4/10). Based on the eligibility criteria of the articles that were systematically reviewed, it would appear that visceral aetiology was not considered in eighty percent of the trials on neck pain, showing a low level of suspicion both in research and clinical settings.

Prevalence of Pain in COPD Patients and Associated Factors: Report From a Population-based Study

OBJECTIVES

To assess the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and migraine among Spanish adults with chronic obstructive pulmonary disease (COPD) compared with non-COPD patients matched by age and sex; and to identify predictors for each of these types of pains among COPD sufferers.

MATERIALS AND METHODS

A cross-sectional study conducted with data collected from the European Health Interview Surveys for Spain (EHSS) conducted in years 2009/2010 (n=22,188) and 2014 (n=22,842). Data were analyzed using multivariable logistic models.

RESULTS

The prevalence of COPD among patients aged 35 years or above were 7.6% (n=1328) for the EHSS 2009 and 5.4% (n=1008) for the EHSS 2014. We matched 2251 COPD patients with age and sex controls. The prevalence of all types of pain were significantly higher among those suffering COPD than those without COPD. For CNP the figures were 40.5% versus 26.1%, for CLBP 44.8% versus 28.4%, and for migraine 22.5% versus 13.2%. Multivariable analysis showed that COPD was associated to a 1.21 (95% confidence interval [CI], 1.02-1.45) higher risk of CNP, 1.38 (95% CI, 1.16-1.64) of CLBP, and 1.36 (95% CI, 1.12-1.65) of migraine. Associated factors with the presence of these types of pain among COPD patients included younger age (not for CLBP), female sex (not for CLBP), "fair/poor/very poor" self-rated health (not for migraine), high blood pressure (not for CNP), mental disorders, obesity (not for migraine), and use of pain medication.

DISCUSSION

The prevalence of CNP, CLBP, and migraine was significantly higher among COPD patients in comparison with controls. Associated factors to suffering these types of pain in patients with COPD included age, sex, self-rated health, certain comorbidities including mental disorders, obesity, and using pain medication.

Low back pain and some associated factors: is there any difference between genders?

OBJECTIVE

To compare men and women with low back pain and identify the prevalence and some of its associated factors in a population-based sample of adults aged 20 and over a seven day period.

METHODS

Cross-sectional study based on a population survey. 600 individuals were interviewed on the following: (1) characteristics of the participants (i.e. demographic, socioeconomic, and labor aspects); (2) physical activity level (IPAQ); (3) musculoskeletal symptoms (Nordic Questionnaire). Descriptive, bivariate, and Poisson regression analyses were performed.

RESULTS

Overall prevalence of LBP was 28.8%, being 39.0% in men and 60.9% in women. The measured associated factors in men were age between 36 and 59 years (PR=3.00 [1.31-6.88]) and over 60 (PR=4.52 [2.02-10.12]), smoking (PR=2.47 [1.20-5.11]), fewer years of formal education (0-4 years) (PR=6.37 [2.15-18.62]), and hypertension (PR=2.27 [1.15-4.50]). For women, the associated factors were occupational activities that involved heavy lifting (PR=1.80 [1.03-3.16]), standing posture leaning forward (PR=2.04 [1.20-3.44]), sitting posture leaning forward (PR=2.17 [1.24-3.82]), and sitting at the computer three or more days per week (PR=4.00 [1.44-11.11]). Widowed or divorced participants were more likely to report LBP, in both men (PR=3.06 [1.40-6.66]) and women (PR=2.11 [1.15-3.88]).

CONCLUSION

This study reveals high prevalence of low back pain in a seven day period. Older age, low education, hypertension, and smoking were associated with LBP in men. Occupational and ergonomic factors were associated with LBP in women. Marital status was associated with LBP in both genders.

Health related quality of life improvement in chronic non-specific neck pain: secondary analysis from a single blinded, randomized clinical trial

BACKGROUND

Chronic non-specific neck pain is related to limited cervical mobility, impaired function, neck muscles myofascial pain syndrome, and stress at work. The aforementioned factors are strongly related and may lead to a negative impact on health-related quality of life. There are some effective conservative Physical therapy interventions for treating chronic non-specific neck pain. Currently, Deep Dry Needling is emerging as an alternative for improving symptoms and consequently, the quality of life in patients with chronic non-specific neck pain. The purpose of the study was to examine the effectiveness of Deep Dry Needling of myofascial trigger points on health-related quality of life improvement, as a secondary analysis, in people with chronic non-specific neck pain.

METHODS

A randomized parallel-group blinded controlled clinical trial was conducted at a public Primary Health Care Centre in Madrid, Spain, from January 2011 to September 2014. One hundred thirty subjects with chronic non-specific neck pain and active myofascial trigger points in neck muscles were randomly allocated into two groups. Subjects in the intervention group (n = 65) were treated with Deep Dry Needling in active myofascial trigger points plus stretching in neck muscles; Control group (n = 65) received only stretching. Both interventions lasted 2 weeks, 2 sessions per week. Health-related quality of life was measured with Short Form-36 (SF-36), in 5 assessments: at baseline, after intervention period; and at 1, 3 and 6 months after intervention.

RESULTS

For both groups, SF-36 mean values increased in all dimensions in every assessment. Significant differences (p < 0.05) were found in favor of the intervention group for all dimensions at the last assessment. For some dimensions (physical function, physical role, social function and vitality), the evidence was more consistent from the beginning.

CONCLUSIONS

Deep Dry Needling plus stretching is more effective than stretching alone for Health-related quality of life improvement, especially for physical function, physical role, social function and vitality dimensions, in people with non-specific neck pain.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN22726482 . Registered 9 October 2011.

Which Seems to Be Worst? Pain Severity and Quality of Life between Patients with Lateral Hip Pain and Low Back Pain

Purpose

The aim of this study was to compare the pain severity, health-related quality of life (HRQoL), and risk of continue having pain with prognostic risk scores (PRS), between patients referring greater trochanteric pain syndrome (GTPS) and chronic low back pain (CLBP).

Methods

A descriptive, cross-sectional design using nonprobability convenience sampling was performed. A total sample of 102 patients were recruited from two primary health-care centers and divided into GTPS (n = 51) and CLBP (n = 51) groups. The primary outcome was pain severity which was assessed with the Spanish version of the Graded Chronic Pain Scale (GCPS). The secondary outcome was the HRQoL which was measured using the Spanish version of EuroQoL Five Dimensions and Five Levels (EQ-5D-5L) as well as the PRS.

Results

Significant differences (P<0.05) were found within both groups in the pain severity global score with a medium effect size showing greater values for the CLBP group with regards to the GTPS group. The PRS in both groups did not show statistical differences (P>0.05). Nevertheless, subjects referring CLBP showed greater levels in the PRS than patients with GTPS. Comparing both groups, the HRQoL showed statistical differences (P<0.05) in the “pain/discomfort” domain in the CLBP group with respect to the GTPS group, but not in the other domains.

Conclusions

Patients who suffered from CLBP showed greater pain severity and HRQoL discomfort with regard to patients with GTPS. Despite greater scores for CLBP, the PRS did not seem to be different between both conditions.

Is there an association between diabetes and neck pain and lower back pain? Results of a population-based study

BACKGROUND

The objective of the study was to study the association between low back pain (LBP), neck pain (NP), and diabetes while controlling for many sociodemographic characteristics, comorbidities, and lifestyle variables. The study also aimed to identify which of these variables is independently associated with LBP and NP among diabetes sufferers.

METHODS

A case-control study using data taken from the European Health Interview Surveys for Spain was conducted in 2009/2010 (n=22,188) and 2014 (n=22,842). We selected subjects ≥40 years of age. Diabetes status was self-reported. One non-diabetic control was matched by the year of survey, age, and sex for each diabetic case. The presence of LBP and NP was defined as the affirmative answer to both of the questions: "Have you suffered chronic LBP/NP over the last 12 months?" and "Has your physician confirmed the diagnosis?" Independent variables included demographic and socioeconomic characteristics, health status variables, lifestyles, and pain characteristics.

RESULTS

The prevalence of NP (32.2% vs 26.8%) and LBP (37.1% vs 30.3%) was significantly higher among those suffering from diabetes. Multivariable analysis showed that diabetes was associated with a 1.19 (95% CI 1.04-1.36) and 1.20 (95% CI 1.06-1.35) higher risk of NP and LBP. Among diabetic subjects, being female, concomitant mental or respiratory disorders, being obese, and physically inactive are variables associated with suffering from these pains. Those suffering NP had 8 times higher risk of reporting LBP than those without NP and the same association is found among those suffering from LBP.

CONCLUSION

The prevalence and intensity of NP and LBP are high among people with diabetes, affecting them significantly more than their age- and sex-matched non-diabetic controls. Specific preventive and educational strategies must be implemented to reduce the incidence, severity, and negative effect on the quality of NP and LBP among diabetic patients.