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Low back pain across the life course

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Summary

Back pain episodes are traditionally regarded as individual events, but this model is currently being challenged in favour of treating back pain as a long-term or lifelong condition. Back pain can be present throughout life, from childhood to older age, and evidence is mounting that pain experience is maintained over long periods: for example, people with pain continue to have it on and off for years, and people without pain do not suddenly develop long-term pain. A number of factors predict back pain presence in epidemiological studies, and these are often present, and predictive, at different life stages. There are also factors present at particular life stages, such as childhood or adolescence, which predict back pain in adulthood. However, there are little published data on long-term pain patterns or predictors over the life course. Such studies could improve our understanding of the development and fluctuations in back pain, and therefore influence treatment approaches.

Section snippets

Background

Historically, the epidemiology of back pain was most commonly studied in adults, predominantly working age adults. Risk factors for back pain were also principally those factors present in adults at the time of onset, or shortly preceding the apparent onset of the condition. This focus was due at least in part to the prevailing belief that back pain was usually due to an injury, often occurring in the workplace. Research studies were often orientated around this model and focussed on the onset

Taking a lifetime perspective

The first challenge in moving on from our historical models of back pain is conceptual – thinking of back pain as a long-term or recurrent condition rather than a series of unrelated episodes. A simple ‘yes/no’ question on previous history of back pain has usually been the only information collected about prior pain experience. It is important to understand that people with no back pain at a point in time are not all the same: some may never have had back pain previously, whereas others may

Prevalence of back pain over the life course

A recent systematic review has estimated the point prevalence of low back pain to be 12%, with a 1-month prevalence around 23% [6]. There is no strong evidence that these figures are different when children, adolescents or the elderly are considered separately. A recent meta-analysis also estimated the point prevalence of back pain among children/adolescents at 12% [7]. This paper and another systematic review indicate that there is a clear rise in prevalence with age among children and

Factors associated with back pain across the life course

In this section, we present information about factors associated with, predictive of or prognostic for back pain at different points in the life course.

Discussion

It is evident that back pain is present from childhood to old age. Three key points draw us to the conclusion that factors present or developing in early life have a lifelong influence on the experiences of back pain: (i) Many of the factors associated with back pain among adults are also present (and associated with pain) among children; (ii) episodes of back pain are related to each other, even when preceded by a traumatic event; and (iii) evidence on the persistence of pain indicates that it

Summary

Back pain research has had a traditional focus on studying episodes of pain, but evidence is mounting that the pain experience should be viewed as a long-term problem, with pain episodes closely linked with each other. Back pain is common throughout the life course, and similar factors are associated with the pain at different times. There is also strong evidence for the links between back pain, pain at other sites and other health problems. This evidence leads to the potential conclusion that

Acknowledgements

KMD is supported by the Wellcome Trust (083572).

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