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ORIGINAL ARTICLE |
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| Year : 2003 | Volume
: 57
| Issue : 4 | Page : 145-147 |
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Incidence of low back pain in workage adults in rural North India.
SC Sharma, R Singh, AK Sharma, R Mittal
Department of Orthopaedics, Paraplegia and Rehabilitation, Postgraduate Institute of Medical Sciences, Rohtak 124001,
| Date of Acceptance | 13-Dec-2002 |
Correspondence Address:
S C Sharma
Department of Orthopaedics, Paraplegia and Rehabilitation, Postgraduate Institute of Medical Sciences, Rohtak 124001
PMID: 14510345
Out
of 11234 patients reporting to our outdoor during June 2001 to June
2002, 2594 patients (23.09%) had low back pain. 4358 roentgenograms were
done in these patients, a mean of 1.68 per patient. These patients were
interviewed and their psychosocial and demographic details were
compared with 1000 controls who did not have back pain but attended
outdoor for other reasons. In the low back pain group, 67% had
psychosocial issues, 57% were in blue-collar jobs, 26% had to
change/leave their profession, and 38% did not enjoy their present job.
All patients had used NSAIDS at some stage of illness and 64% were
advised exercises for the back. The comparative figures in control group
were 19% with psychosocial issues, 34% in blue-collar jobs (heavy
manual workers), 7% had to switch over to new job, 6% did not relish
their present job. Hence, it is concluded that along with exercises and
NSAIDS, sufficient consideration should be given to short centre-based
intensive rehabilitation program followed by a home-based program for
chronic low back pain patients.
Keywords: Adult, Human, Incidence, India, epidemiology,Low Back Pain, epidemiology,Middle Aged,
How to cite this article:
Sharma S
C, Singh R, Sharma A K, Mittal R. Incidence of low back pain in workage
adults in rural North India. Indian J Med Sci 2003;57:145-7 |
Back pain poses an enormous challenge to physicians and other
health care providers. The problem in developing countries is compounded
by ignorance to report for early treatment and occupational compulsions
in rural area. According to Borenstein, low back pain should be viewed
as a medical disorder, with the goal being to return to regular physical
activity as quickly as possible and to enable the patient to receive
the most beneficial care at optimal times.[1] In upto 80% of patients with acute low back pain, a precise anatomic cause cannot be localized.[2]
Typically, an array of non-specific terms are used; lumbago, sprain,
strain, mechanical low back pain and lumbar syndrome. The prognosis for
recovery and full return to function from an episode of acute low back
pain is excellent: 90% of patients are pain free and working within
three months. Though most individuals recover quickly from acute
episode, the risk of recurrence is high: upto 60% within one year.
Keeping
in mind the enormity of the problem, the present study was carried out
to find the psychosocial and demographic problems contributing to
incidence of low back pain.
| ¤ Materials and methods | |  |
This
was a prospective study from June 2001 to June 2002 carried out in our
institution. All the patients in the age group of 20 to 45 years
reporting with complaint of low back pain were interviewed regarding
psychiatric and work related problems. The patients with
clinico-rediological evidence of fracture dislocation, tuberculosis and
tumor of spine were excluded from the study. Low back pain patients due
to prolapsed intervertebral disc, lordo-scoliosis, and listhesis were
also excluded from the study. For control, similar patients who did not
have back pain but attended orthopaedic outdoor for other complaints
were also interviewed. [Table - 1]
| ¤ Observation | | |
Out
of 11234 patients reported to our institution, there were 2594 (23.09%)
patients of low back pain. A total of 4348 roentgenograms were done in
these patients, a mean of 1.68 per patient. Six hundred and eighty four
patients (26.36%) had to change/leave the profession. In 1738 patients
(67%) nonorganic or psychosocial issues were present. One thousand four
hundred and sixty five (57%) were heavy manual workers. Nine hundred and
seventy three patients were compared with 1000 young adults attending
orthopaedic outdoor for reasons other than back pain.
| ¤ Discussion | | |
Back
pain is the second most common reason for visits to office based
physicians. Conventionally, treatment of this problem has revolved
around NSAIDS, physical therapy and spine exercises. Gupta et al have
reported good results using epidural steroids and lignocaine in low
backache patients.[3]
Nonorganic
or psychosocial issues are frequently present in patients with back
pain and often dwarf the organic aspects of patients' problem. The
presence of these issues clearly can impact adversely on the outcome of
treatment. Klenerman, et al have demonstrated that prediction of
chronicity in patients with an episode of acute low back pain was most
successful by assessing the presence of "fear avoidance" variables.[4]
Recent guide lines in the management of low back pain include short
centre based intensive rehabilitation program followed by a home-based
program for chronic low back pain, psychological care of low back pain
patients.[5],[6]
Spinal exercises along with adjuvant physical therapies, if combined
with centre-based short rehabilitation program powered with home-based
program and psychological expertise not only optimise prevention and
treatment of low back pain and help to prevent unnecessary suffering of
the afflicted, in addition offer a contribution - cost containment.
| ¤ References | | |
| 1. | Borenstein DG. Clinician's approach to acute low back pain. Am J Med 1997,102 (suppl. 1A): 16S-22S.  |
| 2. | Deyo
RA, Rainville J, Kent DL. What cam the history and physical examination
tell us about low back pain. JAMA 1992,,268: 760-65. |
| 3. | Gupta
RC, Varma B, Singh SP. Role of epidural hydrocortisone and lignocaine
in low backache. Ind J Orthop 1987,21: 178-82. |
| 4. | Stankovic
R, Johnell 0. Conservative treatment of acute low back pain. A five
year follow-up study of two method of treatment. Spine 1995;
20:469-72. |
| 5. | Genet
F, Poiraudeau S, Revel M. Effectiveness and compliance to a
centre-based short rehabilitation program with a home-based program for
chronic low back pain. Ann Readapt Med Phys 2002, 45:265-72. [PUBMED] [FULLTEXT] |
| 6. | Basler
HD. Deficits in the psychological care of low back pain
patients-comments on the expertise of the expert committee for the
health care system regarding low back pain. Schmerz 2002;
16:215-20. [PUBMED] [FULLTEXT] |
Tables
[Table - 1]
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