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Low back pain: Who’s at risk and why it’s on the rise

If you’re reading this, then you’ve probably experienced low back pain (sometimes referred to as lower back pain or LBP) — it is extremely common and the leading cause of disability across the globe.

In fact, in 2015, The Lancet estimated that as many as 540 million people worldwide had low back pain at any one point. And this number is set to rise.

Disability caused by back pain is particularly high in low and middle-income countries where people can lack access to quality local health care and where health systems pour finances into combating infectious diseases as opposed to treating lifestyle related conditions.

If you’re an expat, it’s worth noting that public health systems in your host country may not be efficiently equipped to treat low back pain. And if you’ve just started a new role overseas or travel frequently for work, the high-pressure situation combined with hours of sitting still — at a desk or in an aeroplane — could make the problem worse.  

Research like Aetna International’s report on opioid addiction in the U.S. highlights how these circumstances can lead individuals to become reliant on prescription medications, which relieve pain but don’t address the root cause. On the flip side, a lack of treatment can also be dangerous, as low back pain is associated with certain underlying, sometimes life-threatening, conditions, including:

  • Inflammatory diseases of the joints (eg arthritis)
  • Osteoporosis (weakening of bones)
  • Fibromyalgia (a condition characterised by pain and fatigue)
  • Infections
  • Spinal stenosis (loss of fluid in the spine)
  • Tumours
  • Kidney stones
  • Endometriosis (uterine tissue growing outside the uterus).

For you as the sufferer, it can be tricky to navigate your way to better health. But armed with the right knowledge and support, you’ll be able to make informed choices about how to tackle early signs of LBP — with exercise or physiotherapy — as well as your long-term treatment options.

This article seeks to address why back pain is so prevalent, who is at risk and what you can do to buck the trend of rising cases of low back pain by making the right lifestyle choices and getting the right treatment for you.

Who is at risk of low back pain?

  • Men versus women: On average, low back pain is most common in women, although in African countries there are more cases of men with back pain (source below). This may be related to traditional gender roles and men being involved more in physical labour in these communities. Women are also at greater risk of LBP during pregnancy due to the increased pressure on the spine. In fact, a study from 2011 revealed that 50 percent of pregnant women report having low back pain, with 80 percent of those affected seeing it impact their everyday lives. It is thought that these numbers could be even higher, as many women accept back pain as part of childbearing and never seek treatment.
  • Occupational influence: While this may not apply to everyone, there are signs that the working population is more affected than those that don’t work. Occupational risk factors account for about 37 percent of LBP globally, increasing to as much as 41 percent in countries lacking high-quality health care. Jobs that require hard labour (such as farming, construction) tend to have the biggest relationship to low back pain due to heavy lifting and vibration of the body. Where occupational hazards are to blame, in the year 2000, it was estimated that an astonishing 818,000  disability-adjusted life years  were lost (due to chronic conditions, disabilities and other issues related to back pain, rather than back pain itself).
  • Age matters: Regarding age, people in their 20s report low back pain the least of all age groups, while women in their 60s and men in their 40s are most affected.
Global average prevalence of low back pain by gender and age graphic from The Lancet Global average prevalence of low back pain by gender and age graphic from The Lancet

Global average prevalence of low back pain by gender and age. Source: The Lancet.

  • Mental health: Mental health can also be a risk factor for back pain. This may in part be related to tension caused by anxiety-related conditions, but could also be linked to the reactions and perceptions of the sufferer. For example, people with depression can become stuck in a cycle: fear of worsening pain leads to inaction, which in turn leads to increased pain and likelihood of disability.
  • Health and fitness: Fitness levels and obesity are linked to LBP. Even if you consider yourself fit, when and how often you exercise can impact your risk. Do you sit at a desk all day then spend the weekend working out? Then you’re more likely to injure your back than people who partake in moderate daily exercise. Starting a new sport also has its risks if you’re using your back muscles in a way they’re not used to.

Those who smoke are three times more likely to suffer from low back pain than their non-smoking peers.

Now we know who is affected by low back pain and who is most at risk, we can begin to unravel why it’s on the increase.

The rise in low back pain

The number of people with chronic low back pain more than doubled between 1992 and 2006 across all ages, genders and ethnicities. The fact that there is a bigger working — as well as ageing — population, could be part of the reason why back pain is increasing globally. As we age, we begin to lose the fluid that cushions the spine, and our bones and muscles get weaker — these factors all contribute to lumbar pain. It makes sense, therefore, that with people living longer, there is naturally an increase in the number of people around the world suffering from age-related musculoskeletal problems.

Interestingly, some have claimed that the apparent increase in low back pain is actually because baby boomers (those now reaching their 60s) are more likely to seek treatment than previous generations.

In terms of the working population, as the charts below show, there has been a dramatic increase over the past few decades in low-income regions, and this is likely to continue increasing in Africa and Southern Asia.

Global Working Population Graphic from The World Showing Increase from 1960-2017. Global Working Population Graphic from The World Showing Increase from 1960-2017.

Global working population from 1960 to 2017. Source: The World Bank

United Nations World Populations Prospect 1950-2070 Working Population by Region Growth Projections Graphic United Nations World Populations Prospect 1950-2070 Working Population by Region Growth Projections Graphic

Working population by region including growth projections. Source: United Nations World Populations Prospect

With poor access to quality health care and a workforce likely to engage in manual labour (eg 60 percent of labourers in sub-Saharan Africa work within agriculture) it’s not surprising that instances of low back pain are increasing in developing countries. Expats in these countries face a similar situation. For example, volunteers and missionaries often take part in physical work, but without private medical insurance, they must rely on local low-quality care.

Sedentary lifestyles may also be to blame for an increase in cases of chronic LBP. It’s estimated in 2016 that 27.5 percent of the global population don’t do enough physical activity. This is largely due to more office-based jobs and accessibility of motorised transport in high-income countries. Areas undergoing rapid development, particularly Latin America and the Caribbean, are at risk of increasing levels of sedentary behaviour.

This is particularly relevant for expats. For those on assignment, increased work pressures can mean long hours at a computer with little time for stretching or exercise. In fact, moving abroad in general can be overwhelming and stressful — making it hard for individuals to find the motivation for exercise.

Tackling back pain

  • Pain management: Drug therapy, specifically opioids, is often the default treatment option for those with low back pain. Unfortunately, taking opioids can result in addiction, as higher and higher doses are required to ease pain as the body adapts to the drugs. It’s a problem that’s been growing for several decades — in the United States, for example, Aetna International reports that deaths associated with opioid addiction have quadrupled since 1999, making it deadlier than the AIDS epidemic at its peak.
  • Physical therapy: Where back pain is caused by prolonged inactivity (such as sitting at a desk) or occupational risks (hard labour) then physical therapy is likely the best option. This can include gentle stretches and exercises set by a physiotherapist or treatment by a chiropractor or osteopath who can manipulate and realign the spine. If you’re abroad on assignment, find out what provisions are included in your health insurance plan — taking advantage of holistic therapies such as these could help you avoid more serious medical intervention later in life.
  • Prevention and early intervention measures: Physical therapy and pain management options often treat the symptoms, rather than the causes of back pain. For example, there are numerous underlying conditions associated with low back pain, such as poor mental and physical fitness and decreasing bone and muscle density that comes with age. Adopting behaviours and measures that help to keep your body strong and supple and your mind healthy will likely result in a reduction in back pain or an avoidance of it as you age. As an expat, it’s important to ensure you have access to high-quality health care — while these causes of back pain are rare, they require diagnosis and treatment.

It’s also important to make lifestyle adjustments to get the best health outcome. Quitting smoking, losing weight by addressing your nutrition and exercise habits can all help prevent and manage back pain.

  • Accessing health and wellness support: If you’ve recently relocated to a new country, live abroad, work long hours or travel frequently for work, it can be hard to make behavioural changes — you may not know where to find the help you need or have a social network in place to offer moral support. Speak to your primary care doctor for a treatment plan that balances pain management, physical therapy and lifestyle changes and works for you. A health and wellness benefits partner, such as Aetna International, can also provide members with the support and resources to help improve your health outcomes. This includes concentrating on the treatment of the condition as opposed to using pain medication to mask symptoms.

Our care and response excellence (CARE) team can reach out to individuals at risk of developing a condition or disease to help guide them to a better health outcome. We advocate for alternatives to long-term pain medication and focus on providing access to treatment such as physical therapy and behavioural support for painful conditions. As is so often the case, an ounce of prevention is worth a pound of cure.

The CARE team’s clinicians can also advise on treatment pathways prescribed for long-term or chronic condition management. This involves providing members with second opinions on recommended treatment and care management, helping to ensure members receive medically appropriate care in the right time, at the right place.

For further information, don't hesitate to contact our friendly team of sales consultants, who'll be able to speak to you about the benefits of international private medical insurance, and the health and wellness support on offer for members.

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Listen to the World Spine Day episode of our Fit for Duty podcast below.

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