Publications
APS Bulletin • Volume 6, Number 6, November/December 1996
The Pain Facts
Michael Von Korff, ScD, Department Editor
Back Pain and Associated Disability in the United States
Ernest Volinn, PhD
Sometimes the facts do not speak for themselves. For instance, in Table 1, all rates of back pain pertain specifically to 1-year prevalence in the United States, but rates range from 7.6% to 56.0% (see column 4). Particular rates depend on the population studied (see column 2) and how back pain was defined (see column 3). The literature includes numerous studies on back pain prevalence in the United States, but given the disparity in findings, what is the actual rate? This unresolved question calls attention to the need for standardized questionnaires based on operational definitions. Such questionnaires would obtain estimates of comparable prevalence rates.
Table 1 suggests, however, that a rank order may be derived for back pain and associated disability. The symptom of back pain is more common, while disability associated with it (as indicated by physician visits and industrial insurance claims for back sprain or strain) is less common. In a year, less than 3% of the population visits a physician for back pain (see column 5), and less than 2% of all eligible workers file an industrial insurance claim for back sprain or strain (see column 6).
Little is known about what produces the common symptom of back pain, and still less is known about the psychosocial triggers that prompt a minority of persons with back pain to seek health care or file an industrial insurance claim (Zola, 1983). Psychosocial factors are likely to exert a greater influence on disability associated with back pain than back pain itself.
References
Carey, T.S., Evans, A.T., Hadler, N.M., Lieberman, W.D., Kalsbeck, W.D., Jackman, A.M., Fryer, J.G., & McNutt, R.A. (1996). Acute severe low back pain: A population based survey of prevalence and care-seeking. Spine, 21, 339-344.
Deyo, R.A., & Tsui-Wu, Y.J. (1987). Descriptive epidemiology of low back pain and its related medical care in the United States. Spine, 12, 264-268.
Guo, H.R., Tanaka, S., & Cameron, L.L. (1995). Back pain among workers in the United States: National estimates and workers at high risk. American Journal of Industrial Medicine, 28, 591-602.
Klein, B.P., Jensen, R.C., & Sanderson, L.M. (1984). Assessment of workers' compensation claims for back strains/sprains. Journal of Occupational Medicine, 26, 443-448.
Rosecrance, J.C., Cook, T.M., & Zimmermann, C.L. (1996). Work-related musculoskeletal symptoms among construction workers in the pipe trades. Work, 7, 13-20.
Taylor, H., & Curran, N.M. (1985). The Nuprin pain report. New York: Louis Harris and Associates.
Volinn, E., Van Koevering, D., & Loeser, J.D. (1991). Back sprain in industry: The role of socioeconomic factors in chronicity. Spine, 16, 542-548.
Zola, I.K. (1983). Socio-medical inquiries. Philadelphia: Temple University Press.
Ernest Volinn is senior research associate at Liberty Mutual Research Center for Safety and Health in Hopkinton, MA.