A prospective analysis of back pain and rates of disability may help explain the association between back pain and mortality.

Back pain is very common, affecting millions of people worldwide.

It is also a major cause of disability and missed work days.

Risk factors such as posture, sedentary lifestyle, weight gain, obesity, and age can all contribute to the development of this condition.

The National Institute of Neurological Disorders and Stroke suggest that around 80% of adults experience back pain at least once in their life.

A US telephone survey showed that the prevalence of chronic back pain more than doubled in the 14-year interval between 1992 and 2006, and that it was greater in women.

Back pain can be acute or chronic. Acute back pain can last for a few days to a couple of weeks, and it usually resolves on its own. Approximately 20% of people with acute low back pain develop chronic low back pain.

Chronic back pain lasts for 3 months or longer. Chronic back pain may be due to underlying conditions such as osteoporosis and cancer.

Measuring the effects of back pain

Researchers from Boston Medical Center in Massachusetts were interested in knowing more about the effects of back pain in women, given the higher prevalence of this condition among women aged 40–80 years, compared with men.

The study, published in The Journal of General Internal Medicine, followed 8,000 older women for an average of 14 years.

"To our knowledge, our study is the first to measure disability after measurement of back pain. This allowed for a prospective analysis of back pain that persisted over time and later rates of disability, which may help explain the association between back pain and mortality," says lead study author Eric Roseen.

The scientists took baseline measurements of back pain and followed up 2 years later. They asked the participants about or observed everyday activities, and many of them had difficulties performing tasks such as walking, meal preparation, and repetitive movements.

Activities such as walking short distances and meal preparation explained almost 50% of the impact of chronic back pain on mortality. Observed walking speed and repetitive standing up from a chair explained about one-quarter of this association (27% and 24%, respectively).

Over 50% of participants died during the follow-up period. Around 65% of women with frequent persistent back pain died during this time, compared with 54% of those without back pain.

Higher mortality risk

The results of the new study show that there may be a strong link between back pain and mortality. Though the reasons behind this association remain unclear, researchers believe that other factors connected to back pain may contribute to an earlier death.

"Back pain may directly impair daily activities, but older adults could inappropriately avoid them due to fear of re-injury or worsening of symptoms. Being unable to perform, or avoiding, daily activities could lead to weight gain, development or progression of other chronic health conditions, and ultimately earlier death," says Roseen.

The older population is increasing worldwide. Around 8% of people are aged 65 and over, and estimates suggest that this number will grow to nearly 17% by 2050.

In light of these statistics, optimizing physical health to extend life for older adults is becoming a priority for public health institutions and research.

"Our findings raise the question of whether better management of back pain across the lifespan could prevent disability, improve quality of life, and ultimately extend life," concludes Roseen.

More research is needed to assess the long-term effects of back pain, but these findings pave the way for future studies that aim to find better treatments, guidelines, and strategies to address this condition.