Back pain is the primary cause of disability in people <50 years of age. The annual incidence in the adult population is 10% to 15% with a point prevalence of approximately 30% in developed countries. Low-back pain (LBP) is second only to upper respiratory problems for physician visits each year, with a lifetime prevalence of 70% to 85%. Despite its widespread prevalence, the general prognosis of acute LBP is favorable, as 90% of patients recover without sequelae.
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Recurrences are common, but most relapses are not disabling. A smaller subset of the population may be incapacitated from chronic LBP, defined as symptoms persistent for >6 months. Depression, job dissatisfaction, and medicolegal issues involving financial compensation predispose a patient to suffer long term.
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Several studies have demonstrated that the longer a patient is absent from work, the less likely he or she will return to work.
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http://www.ncbi.nlm.nih.gov/pubmed/146394?tool=bestpractice.com
Furthermore, a small percentage of patients will develop persistent disabling LBP resulting in immense costs to society. Estimates approach $50 billion per year in the US.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1650784/pdf/amjph00639-0037.pdf
http://www.ncbi.nlm.nih.gov/pubmed/6219588?tool=bestpractice.com
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http://www.ncbi.nlm.nih.gov/pubmed/14749191?tool=bestpractice.com
Several factors have been found to increase the risk of developing disabling LBP. These include maladaptive pain coping behaviors, nonorganic signs, functional impairment, poor general health status, and psychiatric comorbidities.
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Chou R, Shekelle P. Will this patient develop persistent disabling low back pain? JAMA. 2010 Apr 7;303(13):1295-302.
http://www.ncbi.nlm.nih.gov/pubmed/20371789?tool=bestpractice.com
The clinician should be aware of these risk factors when counseling and treating patients.
