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Kim S, Lee SM. Dyslipidemia Is Positively Associated with Chronic Low Back Pain in Korean Women: Korean National Health and Nutrition Examination Survey 2010-2012. Healthcare (Basel) 2024; 12:102. [PMID: 38201008 PMCID: PMC10778792 DOI: 10.3390/healthcare12010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the association between chronic low back pain (CLBP) and chronic diseases, such as hypertension, diabetes, and dyslipidemia. METHODS This study was a retrospective analysis using data from the Korea National Health and Nutrition Examination Survey (KNHANES) between 2010-2012 and included women who answered a questionnaire in the KNHANES asking whether they had low back pain for ≥3 months. Participants were divided into non-CLBP and CLBP groups. For statistical analysis, the Student's t-test, chi-square test, Fisher's exact test, and logistic regression analysis were performed using SPSS. RESULTS Of 5961 participants, the non-CLBP group comprised 4098 women and the CLBP group comprised 1863. Adjusted logistic regression model revealed that dyslipidemia was positively associated with CLBP (odds ratio, 1.32; 95% confidence interval, 1.140, 1.530; p < 0.001). However, hypertension and diabetes were not associated with CLBP. CONCLUSIONS Our results suggest that proper treatment of dyslipidemia may contribute to lowering the risk of CLBP later in life.
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Affiliation(s)
- Sunmin Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-dong 300, Bundang-gu, Seongnam-si 13620, Republic of Korea;
| | - Seon-Mi Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, 73 Koreadae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Chen DQ, Xu WB, Chen X, Xiao KY, Que ZQ, Sun NK, Feng JY, Rui G. Genetically predicted triglycerides mediate the relationship between type 2 diabetes Mellitus and intervertebral disc degeneration. Lipids Health Dis 2023; 22:195. [PMID: 37964277 PMCID: PMC10644578 DOI: 10.1186/s12944-023-01963-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND To validate the causal relationship between type 2 diabetes mellitus (T2DM) and intervertebral disc degeneration (IVDD) and to identify and quantify the role of triglycerides (TGs) as potential mediators. METHODS A two-sample Mendelian randomization (MR) analyses of T2DM (61,714 cases and 1178 controls) and IVDD (20,001 cases and 164,682 controls) was performed using genome-wide association studies (GWAS). Moreover, two-step MR was employed to quantify the proportionate impact of TG-mediated T2DM on IVDD. RESULTS MR analysis showed that T2DM increased IVDD risk (OR: 1.0466, 95% CI 1.0049-1.0899, P = 0.0278). Reverse MR analyses demonstrated that IVDD does not affect T2DM risk (P = 0.1393). The proportion of T2DM mediated through TG was 11.4% (95% CI 5.5%-17.4%). CONCLUSION This work further validates the causality between T2DM and IVDD, with a part of the effect mediated by TG, but the greatest impacts of T2DM on IVDD remain unknown. Further studies are needed to identify other potential mediators.
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Affiliation(s)
- Ding-Qiang Chen
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Wen-Bin Xu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xin Chen
- Department of Cardiac Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Ke-Yi Xiao
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Zhi-Qiang Que
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Nai-Kun Sun
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jin-Yi Feng
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Gang Rui
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
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Hanidu I, Johnson R, Ahorukomeye P, Ahn NU. Association Between Hypercholesterolemia and Lumbar Degenerative Back Pain: A Medicare Expenditure Panel Survey (MEPS) Study. Cureus 2023; 15:e47930. [PMID: 38034239 PMCID: PMC10684830 DOI: 10.7759/cureus.47930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Hypercholesterolemia is known to be a major contributor to the morbidity associated with cardiovascular disease and has been hypothesized to result in degenerative changes to the spine through atherosclerosis of segmental lumbar vessels. The purpose of this study is to determine the relationship between hypercholesterolemia and degenerative lumbar spine conditions in a U.S. cohort. Methods A total of 30,461 participated in the 2018 Medicare Expenditure Panel Survey (MEPS). Of those, 1,063 subjects responded to whether a diagnosis of lumbar disorders with low back pain was present. Odds ratios (OR) were calculated, and logistic regression analyses were adjusted for demographic, education, occupation, cardiovascular and mental health conditions. Results Of the 1,063 respondents, 455 (43%) reported back pain. Mean age of the respondents was 62.7±16.1. Men and women reported back pain at similar rates (43% vs 45%, p=0.664). Age, race, education level and occupation were similar between those with and without back pain (p>0.05). Those with a diagnosis of depression had higher odds of having back pain (p<0.05). Prevalence of back pain in subjects who responded to the back pain diagnosis item on the survey was 42.6%. On univariate analysis, diagnosis of total cholesterol levels was significantly higher in those with a diagnosis of back pain (OR 1.36, 95% CI [1.20-1.54], p<.0001). Multivariable analysis showed that hypercholesterolemia was independently associated with back pain (adjusted OR 1.32, 95% CI [1.04-1.68], p=0.021) after controlling for covariates. Conclusions In this study, subjects with hypercholesterolemia were 34% more likely to have back pain after controlling for confounders which presents as a recent discovery amongst U.S. populations. Further studies should be performed to investigate the management of hypercholesterolemia in the development and progression of degenerative lumbar back pain.
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Affiliation(s)
- Idris Hanidu
- Orthopedic Surgery, University of Illinois at Chicago, Chicago, USA
| | - Ryan Johnson
- Orthopedic Surgery, Meharry Medical College School of Medicine, Atlanta, USA
| | - Peter Ahorukomeye
- Orthopedic Surgery, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Nicholas U Ahn
- Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
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Li X, Wang Y, Zhang Y, Ma Y, Pan F, Laslett L, Cai G. Longitudinal associations of body mass index and abdominal circumference with back pain among community-dwelling adults: data from the Osteoarthritis Initiative. Spine J 2023; 23:1007-1014. [PMID: 37030576 DOI: 10.1016/j.spinee.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/20/2023] [Accepted: 03/22/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND CONTEXT Back pain is the most common musculoskeletal problem in both developed and developing countries. The prevalence and burden of back pain increases with age, and the management of back pain becomes increasingly important in the context of global aging. There is increasing evidence that obesity is a modifiable risk factor for musculoskeletal pain in different locations. Understanding the role of obesity in back pain holds great potential for improving understanding of the mechanisms of back pain and for developing new preventive and therapeutic approaches. PURPOSE To evaluate the role of weight, body mass index (BMI) and abdominal circumference (AC) in risk of back pain over 96 months. DESIGN Prospective cohort study. PATIENT SAMPLE The sample was from 4,793 adults in the Osteoarthritis Initiative (OAI) database who had or were at increased risk for knee Osteoarthritis. OUTCOME MEASURES Outcome variables included the presence, severity, and frequency of back pain, using the past 30 days as the time frame. METHODS Longitudinal analysis of data from 4,793 participants enrolled in the Osteoarthritis Initiative, assessed every 12 or 24 months for weight, BMI (kg/m2), AC (cm), and presence, severity (none, mild, moderate, severe), and frequency (none, rarely, sometimes, often, always) of back pain. BMI and AC were decomposed into between-person and with-person components. Data analyses were performed using mixed-effects logistic (for presence of back pain) or ordered logistic regression (for severity and frequency of back pain) models. RESULTS Back pain was reported in 58% of participants at baseline; 70% of those without back pain had incident back pain over 96 months. Both between-person (average value across a participant's all measurements) and within-person (deviations from the participant's average) effects of weight and BMI increased risk of presence, severity, and frequency of back pain (Odds radios (OR) per kg/m2: 1.010-1.046, p<.05) in females but not males, with statistically significant weight*sex and BMI*sex interactions. Similar findings were observed for between-person effects of AC on back pain, and the within-person effect of AC was only associated with back pain severity (OR per cm: 1.009, 95% confidence interval 1.002-1.017, p=.019) in females. CONCLUSIONS Greater average weight and BMI and increases in them increased odds of presence, severity, and frequency of back pain over 96 months in middle aged and older women but not men. Only average AC increased odds of back pain over time, in women. These findings suggest that preventing obesity and slowing weight gain is important for the management of back pain.
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Affiliation(s)
- Xiaoxi Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yining Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Youyou Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Laura Laslett
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Tasmania, Australia
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, 230032, Anhui, China.
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Gupta N, Rasmussen CL, Hartvigsen J, Mortensen OS, Clays E, Bültmann U, Holtermann A. Physical Activity Advice for Prevention and Rehabilitation of Low Back Pain- Same or Different? A Study on Device-Measured Physical Activity and Register-Based Sickness Absence. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:284-294. [PMID: 34626301 PMCID: PMC9232440 DOI: 10.1007/s10926-021-10005-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 05/15/2023]
Abstract
Purpose We lack knowledge on whether the advice of "being physically active" should be the same for prevention and rehabilitation of low back pain (LBP). Sickness absence is a key outcome for LBP prevention and rehabilitation. We investigated the associations between physical activity and long-term sickness absence (LTSA) among employees with and without LBP. Methods Between 2011 and 2013, 925 Danish employees wore a Actigraph GTX3 accelerometer for 1-5 workdays to measure physical activity and reported LBP in past 7 days. Employees were followed for 4 years to determine their first register-based LTSA event (≥ 6 consecutive weeks). Results Among employees with LBP, increasing moderate-to-vigorous-intensity physical activity at work by 20 min and decreasing the remaining behaviors at work (ie., sitting, standing and light-intensity activity) by 20 min was associated with 38% (95% CI 17%; 63%) higher LTSA risk. Increasing light-intensity activity at work by 20 min and decreasing 20 min from the remaining behaviors was associated with 18% (95% CI 4%; 30%) lower risk. During leisure, increasing moderate-to-vigorous-intensity activity by 20 min or standing by 40 min was associated with 26% (95% CI 3%; 43%) lower and 37% (95% CI 0%; 87%) higher risk, respectively. Among employees without LBP, we found no such associations. Conclusions The physical activity advice ought to be different for LBP prevention and rehabilitation to reduce LTSA risk, and specified by domain and activity intensity. At work, employees with LBP should be advised to spend time on light-intensity physical activity and limit their time on moderate-to-vigorous-intensity physical activity. During leisure, employees should spend time on moderate-to-vigorous-intensity physical activity.
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Affiliation(s)
- Nidhi Gupta
- National Research Centre for the Working Environment, Lerso Parkalle 105, 2100, Copenhagen, Denmark.
| | - Charlotte Lund Rasmussen
- National Research Centre for the Working Environment, Lerso Parkalle 105, 2100, Copenhagen, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Ole Steen Mortensen
- Department of Occupational- and Social Medicine, Holbæk Hospital, Copenhagen University Hospital, Holbæk, Denmark
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Lerso Parkalle 105, 2100, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Prevalence of pain in community-dwelling older adults with hypertension in the United States. Sci Rep 2022; 12:8387. [PMID: 35589916 PMCID: PMC9119929 DOI: 10.1038/s41598-022-12331-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/09/2022] [Indexed: 12/03/2022] Open
Abstract
Hypertension and pain are both prevalent conditions in the older adult population. We aimed to report the prevalence of pain discomforts and investigated the association between hypertension and pain discomforts among older adults in the United States. Data from the 2011 National Health and Aging Trends Study were analyzed. In-person interviews were conducted in 7601 adults ages ≥ 65 years. Prevalence of bothersome pain, activity-limiting pain, locations of pain and usage of pain medicine were evaluated. Demographics, comorbidities, and other covariates were compared between older adults with hypertension and those without. Multivariate regression was further performed to yield adjusted odd ratios. Among 6825 older adults, 4533 of them had a history of hypertension while 2272 of them had not. Prevalence of bothersome pain (57.12% versus 44.81%, p < 0.001) and activity-limiting pain (56.21% versus 46.12%, p < 0.001) were significantly higher in the hypertension group. After adjusting for all covariates, hypertension demonstrated a significant association with activity-limiting pain (OR 1.63, 95% CI 1.06 to 2.52, p = 0.02). In conclusion, pain was more prevalent in older Americans with hypertension. The positive association between hypertension and pain suggested that routine pain assessment and proper treatment would be required to improve the function and quality of life among older adults especially with hypertension.
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Prevalence and Risk Factors Associated with Low Back Pain in the Saudi Adult Community: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413288. [PMID: 34948895 PMCID: PMC8702019 DOI: 10.3390/ijerph182413288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022]
Abstract
Worldwide, low back pain is common and linked with many risk factors. There is a lack of studies in the Saudi Arabian community on low back pain prevalence and risk factors. Therefore, the present research will investigate the prevalence of low back pain in the middle-aged and elderly community population and examine the risk factors contributing to low back pain in Saudi Arabia. The present paper is a cross-sectional study of the community living in Riyadh and the surrounding areas in Saudi Arabia. Data were collected between October 2019 and April 2020 via trained research assistants. A total of 276 participants were included in the analysis. The prevalence of low back pain was 27.9% (n = 77) among the participants included in this study. All participants reported low back pain severity with a mean of 4.35 ± 2.19 on the pain rating scale. Older age, arthritis, hypertension, anemia, osteoporosis, and a history of fractures were all associated with having LBP. Low back pain is highly prevalent in the Saudi community adult population living in Riyadh and its surrounding areas. More than a fourth of the sample reported experiencing back pain. The study outlines several modifiable risk factors (BMI, education, employment status, marital status, and smoking status) and unmodifiable risk factors (arthritis, hypertension, anemia, osteoporosis, and a history of fractures) associated with low back pain in the study sample.
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Chen F, Wu T, Bai C, Guo S, Huang W, Pan Y, Zhang H, Wu D, Fu Q, Chen Q, Li X, Li L. Serum apolipoprotein B/apolipoprotein A1 ratio in relation to intervertebral disk herniation: a cross-sectional frequency-matched case-control study. Lipids Health Dis 2021; 20:79. [PMID: 34325707 PMCID: PMC8320064 DOI: 10.1186/s12944-021-01502-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/12/2021] [Indexed: 12/04/2022] Open
Abstract
Study design This was a cross-sectional frequency-matched case–control study. Background and aim The serum lipid profile of lipoprotein(a) [Lp(a)] level and apolipoprotein B/apolipoprotein A1 ratio (Apo B/Apo A1) ratio were found to be more representative for serum lipid level and were recognized as the independent risk factors for various diseases. Although the blood levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were found to be associated with symptomatic intervertebral disk herniation (IDH), no studies to date have evaluated the association of Apo AI, Apo B, Lp(a), and Apo B/Apo AI levels with symptomatic IDH. This study aimed to assess the link between blood lipid levels and symptomatic IDH. Method The study included 1839 Chinese patients. Of these, 918 patients were diagnosed with IDH and enrolled in the experimental group. A control group of 921 patients underwent a physical examination during the same period. The serum lipid levels of TC, TG, LDL-C, HDL-C, Lp(a), Apo B, and Apo B/Apo AI were examined and analyzed. The control group comprised randomly selected patients who met the baseline levels of the aforementioned lipid molecules. Results Patients with IDH exhibited significantly higher TC, TG, LDL, Apo B, and Lp(a) levels than controls. The percentage of high TC, high TG, high LDL, high Apo B, and high Lp(a) were obviously higher in the IDH group than in the control group. However, hyperlipidemia had no relationship with the degenerated segment of the IDH (P = 0.201). The odds ratio (OR) for the incidence of IDH with elevated levels of LDL-C, TC, TG, Lp(a), Apo B, and Apo B/Apo AI was 1.583, 1.74, 1.62, 1.58, 1.49, and 1.39, respectively. The correlation analysis revealed the correlation between elevated LDL-C, TC, TG, Apo B, Lp(a), and incidence of IDH was significant (R2LDL = 0.017; R2TC = 0.004; R2TG = 0.015; R2Apo B = 0.004; R2Lp(a) = 0.021) (P < 0.05). Conclusion This study suggested that elevated levels of serum TC, TG, LDL, Apo B, Lp(a), and Apo B/Apo AI were associated with a higher risk of IDH. This study provided useful information to identify a population that might be at risk of developing IDH based on elevated lipid levels.
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Affiliation(s)
- Fei Chen
- Department of Cardiovascular, Pingxiang Hospital of Southern Medical University, Pingxiang, Jiangxi Province, 337055, China
| | - Tongde Wu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China
| | - Chong Bai
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China
| | - Song Guo
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China
| | - Wenjun Huang
- Department of Cardiovascular, Pingxiang Hospital of Southern Medical University, Pingxiang, Jiangxi Province, 337055, China
| | - Yaqin Pan
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China
| | - Huiying Zhang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China
| | - Desheng Wu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China
| | - Qiang Fu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China
| | - Qi Chen
- Department of Cardiovascular, The Second Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, People's Republic of China.
| | - Xinhua Li
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China. .,Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China.
| | - Lijun Li
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China.
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Yoshimoto T, Ochiai H, Shirasawa T, Nagahama S, Uehara A, Sai S, Kokaze A. Sex differences in the association of metabolic syndrome with low back pain among middle-aged Japanese adults: a large-scale cross-sectional study. Biol Sex Differ 2019; 10:33. [PMID: 31277712 PMCID: PMC6612171 DOI: 10.1186/s13293-019-0249-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/27/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although some recent studies have indicated an association between metabolic syndrome (MetS) and musculoskeletal disease, little is known about the association of MetS with low back pain (LBP). The present study aimed to investigate sex differences in the association of MetS and the clustering of MetS components with LBP among middle-aged Japanese individuals. METHODS Study subjects were 45,192 adults (30,695 men, 14,497 women) aged 40-64 years who underwent annual health checkups conducted from April 2013 to March 2014. MetS was defined according to the criteria of the Examination Committee of Criteria for MetS in Japan as abdominal obesity plus at least two of dyslipidemia, high blood pressure, or high blood glucose. Information on LBP and health-related lifestyles were collected using a self-administered questionnaire. Logistic regression modeling was used to calculate the odds ratio (OR) and 95% confidence interval (CI) for LBP. RESULTS After adjusting for age and lifestyle factors, the OR of MetS for LBP was 1.15 (95% CI 0.95-1.40) in men and 2.16 (95% CI 1.32-3.53) in women. Compared to subjects without abdominal obesity, the presence of abdominal obesity significantly increased the OR for LBP among men (abdominal obesity only: OR 1.34, 95% CI 1.02-1.76; abdominal obesity plus one component: OR 1.24, 95% CI 1.01-1.52; abdominal obesity plus two or more components: OR 1.26, 95% CI 1.02-1.55). Among women, adding other components of MetS to abdominal obesity significantly increased ORs for LBP (abdominal obesity only: OR 1.70, 95% CI 0.94-3.08; abdominal obesity plus one component: OR 1.66, 95% CI 1.06-2.60; abdominal obesity plus two or more components: OR 2.30, 95% CI 1.41-3.78). CONCLUSIONS This large-scale cross-sectional study indicated that MetS was significantly associated with LBP among women only and that a sex-difference existed in the association between the clustering of MetS components and LBP. Clustering of MetS components by sex may need to be considered for the prevention of LBP, although further prospective studies are needed to clarify the causality.
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Affiliation(s)
- Takahiko Yoshimoto
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Hirotaka Ochiai
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Takako Shirasawa
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Satsue Nagahama
- All Japan Labor Welfare Foundation, 6-16-11 Hatanodai, Shinagawa-ku, Tokyo, 142-0064 Japan
| | - Akihito Uehara
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Shogo Sai
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
| | - Akatsuki Kokaze
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555 Japan
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Virtanen M, Ervasti J, Head J, Oksanen T, Salo P, Pentti J, Kouvonen A, Väänänen A, Suominen S, Koskenvuo M, Vahtera J, Elovainio M, Zins M, Goldberg M, Kivimäki M. Lifestyle factors and risk of sickness absence from work: a multicohort study. LANCET PUBLIC HEALTH 2019; 3:e545-e554. [PMID: 30409406 PMCID: PMC6220357 DOI: 10.1016/s2468-2667(18)30201-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/23/2023]
Abstract
Background Lifestyle factors influence the risk of morbidity and mortality, but the extent to which they are associated with employees' absence from work due to illness is unclear. We examined the relative contributions of smoking, alcohol consumption, high body-mass index, and low physical activity to diagnosis-specific sickness absence. Methods We did a multicohort study with individual-level data of participants of four cohorts from the UK, France, and Finland. Participants' responses to a lifestyle survey were linked to records of sickness absence episodes, typically lasting longer than 9 days; for each diagnostic category, the outcome was the total number of sickness absence days per year. We estimated the associations between lifestyle factors and sickness absence by calculating rate ratios for the number of sickness absence days per year and combining cohort-specific estimates with meta-analysis. The criteria for assessing the evidence included the strength of association, consistency across cohorts, robustness to adjustments and multiple testing, and impact assessment by use of population attributable fractions (PAF), with both internal lifestyle factor prevalence estimates and those obtained from European populations (PAFexternal). Findings For 74 296 participants, during 446 478 person-years at risk, the most common diagnoses for sickness absence were musculoskeletal diseases (70·9 days per 10 person-years), depressive disorders (26·5 days per 10 person-years), and external causes (such as injuries and poisonings; 12·8 days per 10 person-years). Being overweight (rate ratio [adjusted for age, sex, socioeconomic status, and chronic disease at baseline] 1·30, 95% CI 1·21–1·40; PAFexternal 8·9%) and low physical activity (1·23, 1·14–1·34; 7·8%) were associated with absences due to musculoskeletal diseases; heavy episodic drinking (1·90, 1·41–2·56; 15·2%), smoking (1·70, 1·42–2·03; 11·8%), low physical activity (1·67, 1·42–1·96; 19·8%), and obesity (1·38, 1·11–1·71; 5·6%) were associated with absences due to depressive disorders; heavy episodic drinking (1·64, 1·33–2·03; 11·3%), obesity (1·48, 1·27–1·72; 6·6%), smoking (1·35, 1·20–1·53; 6·3%), and being overweight (1·20, 1·08–1·33; 6·2%) were associated with absences due to external causes; obesity (1·82, 1·40–2·36; 11·0%) and smoking (1·60, 1·30–1·98; 10·3%) were associated with absences due to circulatory diseases; low physical activity (1·37, 1·25–1·49; 12·0%) and smoking (1·27, 1·16–1·40; 4·9%) were associated with absences due to respiratory diseases; and obesity (1·67, 1·34–2·07; 9·7%) was associated with absences due to digestive diseases. Interpretation Lifestyle factors are associated with sickness absence due to several diseases, but observational data cannot determine the nature of these associations. Future studies should investigate the cost-effectiveness of lifestyle interventions aimed at reducing sickness absence and the use of information on lifestyle for identifying groups at risk. Funding NordForsk, British Medical Research Council, Academy of Finland, Helsinki Institute of Life Sciences, and Economic and Social Research Council.
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Affiliation(s)
- Marianna Virtanen
- Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden; Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki and Turku, Finland
| | - Jenny Head
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Helsinki and Turku, Finland
| | - Paula Salo
- Finnish Institute of Occupational Health, Helsinki and Turku, Finland; Department of Psychology, University of Turku, Turku, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki and Turku, Finland; School of Social Policy, Sociology and Social Research, University of Kent, UK
| | - Sakari Suominen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; University of Skövde, Skövde, Sweden; Folkhälsan Research Center, Helsinki, Finland
| | | | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Marie Zins
- Inserm, Population-based Epidemiologic Cohorts Unit UMS 011, Villejuif, France; Paris Descartes University, Paris, France
| | - Marcel Goldberg
- Inserm, Population-based Epidemiologic Cohorts Unit UMS 011, Villejuif, France; Paris Descartes University, Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK; Clinicum, Faculty of Medicine, University of Helsinki, Finland
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Low back pain and some associated factors: is there any difference between genders? Braz J Phys Ther 2019; 24:79-87. [PMID: 30782429 DOI: 10.1016/j.bjpt.2019.01.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare men and women with low back pain and identify the prevalence and some of its associated factors in a population-based sample of adults aged 20 and over a seven day period. METHODS Cross-sectional study based on a population survey. 600 individuals were interviewed on the following: (1) characteristics of the participants (i.e. demographic, socioeconomic, and labor aspects); (2) physical activity level (IPAQ); (3) musculoskeletal symptoms (Nordic Questionnaire). Descriptive, bivariate, and Poisson regression analyses were performed. RESULTS Overall prevalence of LBP was 28.8%, being 39.0% in men and 60.9% in women. The measured associated factors in men were age between 36 and 59 years (PR=3.00 [1.31-6.88]) and over 60 (PR=4.52 [2.02-10.12]), smoking (PR=2.47 [1.20-5.11]), fewer years of formal education (0-4 years) (PR=6.37 [2.15-18.62]), and hypertension (PR=2.27 [1.15-4.50]). For women, the associated factors were occupational activities that involved heavy lifting (PR=1.80 [1.03-3.16]), standing posture leaning forward (PR=2.04 [1.20-3.44]), sitting posture leaning forward (PR=2.17 [1.24-3.82]), and sitting at the computer three or more days per week (PR=4.00 [1.44-11.11]). Widowed or divorced participants were more likely to report LBP, in both men (PR=3.06 [1.40-6.66]) and women (PR=2.11 [1.15-3.88]). CONCLUSION This study reveals high prevalence of low back pain in a seven day period. Older age, low education, hypertension, and smoking were associated with LBP in men. Occupational and ergonomic factors were associated with LBP in women. Marital status was associated with LBP in both genders.
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12
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Yoshimoto T, Ochiai H, Shirasawa T, Nagahama S, Kobayashi M, Minoura A, Miki A, Chen Y, Hoshino H, Kokaze A. Association between serum lipids and low back pain among a middle-aged Japanese population: a large-scale cross-sectional study. Lipids Health Dis 2018; 17:266. [PMID: 30474551 PMCID: PMC6260842 DOI: 10.1186/s12944-018-0907-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/08/2018] [Indexed: 01/23/2023] Open
Abstract
Background Abnormal lipid levels have been suggested as a mechanism leading to atherosclerosis of the lumbar vessels, resulting in low back pain (LBP). This study examined whether abnormal lipid levels were associated with LBP among middle-aged adults in Japan. Methods The present study included adults between 40 and 64 years old who underwent an annual health checkup. A total of 258,367 eligible participants were analyzed to investigate associations of LBP with low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and LDL-C/HDL-C ratio. Participants were categorized into two groups according to each of LDL-C, HDL-C, and LDL-C/HDL-C ratio (LDL-C: ≥ 140 vs. < 140 mg/dL; HDL-C: ≥ 40 vs. < 40 mg/dL; LDL-C/HDL-C ratio: ≥ 2.5 vs. < 2.5). Information on LBP was obtained using a self-administered questionnaire. Logistic regression modeling was used to calculate the odds ratio (OR) and 95% confidence interval (CI) for LBP. Results The prevalence of LBP was 2.2% in men and 2.1% in women. Multivariable analysis adjusting for age, body mass index, and lifestyle factors found significant associations for HDL-C < 40 mg/dL (OR, 1.34; 95%CI, 1.20–1.48 in men; OR, 1.32; 95%CI, 1.02–1.72 in women) and LDL-C/HDL-C ratio ≥ 2.5 (OR, 1.17; 95%CI, 1.09–1.26 in men; OR, 1.15; 95%CI, 1.03–1.29 in women) with LBP. Conclusions Low HDL-C and high LDL-C/HDL-C ratio were significantly associated with LBP in a middle-aged Japanese population. These findings might support the atherosclerosis-LBP hypothesis.
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Affiliation(s)
- Takahiko Yoshimoto
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Hirotaka Ochiai
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Takako Shirasawa
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Satsue Nagahama
- All Japan Labor Welfare Foundation, 6-16-11 Hatanodai, Shinagawa-ku, Tokyo, 142-0064, Japan
| | - Mariko Kobayashi
- All Japan Labor Welfare Foundation, 6-16-11 Hatanodai, Shinagawa-ku, Tokyo, 142-0064, Japan
| | - Akira Minoura
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Ayako Miki
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Yingli Chen
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Hiromi Hoshino
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Akatsuki Kokaze
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
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Beierfuß A, Dietrich H, Kremser C, Hunjadi M, Ritsch A, Rülicke T, Thomé C, Mern DS. Knockout of Apolipoprotein E in rabbit promotes premature intervertebral disc degeneration: A new in vivo model for therapeutic approaches of spinal disc disorders. PLoS One 2017; 12:e0187564. [PMID: 29099857 PMCID: PMC5669473 DOI: 10.1371/journal.pone.0187564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 10/23/2017] [Indexed: 12/12/2022] Open
Abstract
Intervertebral disc (IVD) degeneration that accelerates the loss of disc structural and functional integrities is recognized as one of the major factors of chronic back pain. Cardiovascular risk factors, such as deficits of apolipoproteins that elevate the levels of cholesterol and triglycerides, are considered critical for the progress of atherosclerosis; notably in the abdominal aorta and its lumbar branching arteries that supply lumbar vertebrae and IVDs. Obstruction of the lumbar arteries by atherosclerosis is presumed to promote lumbar disc degeneration and low back pain. APOE-knockout rabbits have recently been shown to generate hyperlipidemia with increased levels of cholesterol and triglycerides that mimic the symptoms of atherosclerosis in humans. Here, we analysed IVD degeneration in the lumbar spines of ten homozygous APOE-knockout and four wild-type New Zealand White rabbits of matching age to prove accelerated IVD degeneration in APOE-knockout rabbits, since APOE-knockout rabbits could be a beneficial model for therapeutic approaches of degenerative IVD disorders. Experiments were performed using T1/T2-weighted magnetic resonance imaging, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, glucose-oxidase assay, enzyme-linked immunosorbent assay, quantitative reverse transcription PCR and western blot. APOE-knockout lumbar spines showed more advanced IVD degeneration, obstructed lumbar arteries and lower enhancement of contrast agent in IVDs. Moreover, lower concentration of glucose, lower number of viable cells and lower concentrations of aggrecan, collagen II and higher concentration of collagen I were detected in APOE-knockout IVDs (p < 0.0001). APOE-knockout in rabbits could induce structurally deteriorating premature IVD degeneration that mimics the symptoms of accelerated IVD degeneration in humans. APOE-knockout rabbits could be used as beneficial model, as they can bypass the standard surgical interventions that are commonly applied in research animals for the induction of enhanced IVD degeneration. Their parallel use in therapeutic approaches of IVD disorders and atherosclerosis could reduce the number of research animals to be used and contribute to the principles of 3Rs (Replacement, Reduction and Refinement).
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Affiliation(s)
- Anja Beierfuß
- Central Laboratory Animal Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Hermann Dietrich
- Central Laboratory Animal Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kremser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Hunjadi
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Ritsch
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Rülicke
- Institute of Laboratory Animal Science, University of Veterinary Medicine Vienna, Veterinaerplatz 1, Vienna, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
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Shiri R, Falah-Hassani K. Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies. Br J Sports Med 2017; 51:1410-1418. [DOI: 10.1136/bjsports-2016-097352] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/03/2022]
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The Association Between Atherosclerosis and Low Back Pain: A Systematic Review. PM R 2017; 9:1144-1156. [PMID: 28461227 DOI: 10.1016/j.pmrj.2017.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 04/08/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the evidence of association between atherosclerosis and low back pain (LBP). TYPE: Focused systematic review. LITERATURE SURVEY PubMed, Web of Science, CINAHL, and EMBASE were searched for original research articles, not limited by language, from January 1, 1990, to October 31, 2016. METHODOLOGY Titles and then abstracts were identified using predefined search terms and excluded based on lack of relevancy. This was followed by full-text reviews. Two authors independently assessed methodological quality based on Cochrane Handbook for Systematic Reviews of Interventions. SYNTHESIS A total of 26 studies met the inclusion criteria. The quality of the studies was low to moderate. There was significant heterogeneity across articles with respect to methodology. There was insufficient evidence to support an association between ischemia and low back pain. CONCLUSIONS The cause of LBP remains poorly understood. Better insight into how intervertebral disk changes relate to LBP is needed to guide future research. High-quality prospective studies are needed to answer the question of whether atherosclerosis is a risk factor for LBP. LEVEL OF EVIDENCE II.
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16
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Suri P, Boyko EJ, Smith NL, Jarvik JG, Williams FMK, Jarvik GP, Goldberg J. Modifiable risk factors for chronic back pain: insights using the co-twin control design. Spine J 2017; 17:4-14. [PMID: 27794503 PMCID: PMC6126929 DOI: 10.1016/j.spinee.2016.07.533] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/29/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Inconsistent associations between modifiable risk factors and chronic back pain (CBP) may be due to the inability of traditional epidemiologic study designs to properly account for an array of potential genetic and environmental confounding factors. The co-twin control research design, comparing modifiable risk factors in twins discordant for CBP, offers a unique way to remove numerous confounding factors. PURPOSE The study aimed to examine the association of modifiable lifestyle and psychological factors with lifetime CBP. STUDY DESIGN/SETTING This is a cross-sectional co-twin control study in a nationwide sample of male twin members of the Vietnam Era Twin Registry. PATIENT SAMPLE The sample is composed of 7,108 participants, including 1,308 monozygotic (MZ) pairs and 793 dizygotic pairs. OUTCOME MEASURE The outcome measure is the self-reported lifetime history of CBP. METHODS Lifestyle factors included body mass index (BMI), smoking history, alcohol consumption, habitual physical activity, and typical sleep duration. Psychological factors included depression (Patient Health Questionnaire-9) and posttraumatic stress disorder (PTSD) symptoms (PTSD Checklist). Covariates included age, race, education, and income. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated for the association of risk factors with lifetime CBP when considering twins as individuals, and a within-pair co-twin control analysis that accounted for familial and genetic factors. Funding was through VA Grant 5IK2RX001515; there were no study-specific conflicts of interest. RESULTS The mean age of respondents was 62 years and the prevalence of lifetime CBP was 28%. All lifestyle factors were associated with CBP in the individual level analysis. However, none of these persisted in the within-pair analyses, except for severe obesity (BMI ≥35.0), which was associated with lifetime CBP in both individual-level (OR=1.6, 95% CI: 1.3-1.9) and within-pair analyses (MZ analysis: OR=3.7, 95% CI: 1.2-11.4). Symptoms of PTSD and depression were strongly associated with lifetime CBP in both the individual-level (moderate or severe depression: OR=4.2, 95% CI: 3.6-4.9, and severe PTSD: OR=4.8, 95% CI: 4.0-5.7) and within-pair (MZ) analyses (moderate or severe depression: OR=4.6, 95% CI: 2.4-8.7, and severe PTSD: OR=3.2, 95% CI: 1.6-6.5). CONCLUSIONS Many associations between modifiable lifestyle risk factors and CBP are due to confounding by familial and genetic factors. Severe obesity, depression, and PTSD should be considered in the development of intervention strategies to reduce the prevalence of CBP.
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Affiliation(s)
- Pradeep Suri
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; Division of Rehabilitation Care Services, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Rehabilitation Medicine, University of Washington, 325 Ninth Ave, Box 359612, Seattle, WA 98104, USA.
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; General Medicine Service, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific St Health Sciences Bldg, Box 357236, Seattle, WA 98195, USA
| | - Jeffrey G Jarvik
- Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 4333 Brooklyn Ave NE, Box #359455, Seattle, WA 98195, USA; Department of Radiology, University of Washington, 325 9th Ave, Seattle, WA 98104, USA; Department of Neurological Surgery, University of Washington, 325 9th Ave, Seattle, WA 98104, USA; Department of Health Services, University of Washington, 325 9th Ave, Seattle, WA 98104, USA
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, Kings College London, Strand, London WC2R 2LS, UK
| | - Gail P Jarvik
- Department of Medicine (Medical Genetics), 3720 15th Ave NE, Seattle, WA 98105, USA; Department of Genome Sciences, University of Washington, 3720 15th Ave NE, Seattle, WA 98105, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, S-152-ERIC, 1660 S. Columbian Way, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington, 1959 NE Pacific St Health Sciences Bldg, Box 357236, Seattle, WA 98195, USA
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Serum lipid levels are positively correlated with lumbar disc herniation--a retrospective study of 790 Chinese patients. Lipids Health Dis 2016; 15:80. [PMID: 27090514 PMCID: PMC4836107 DOI: 10.1186/s12944-016-0248-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/14/2016] [Indexed: 01/10/2023] Open
Abstract
Background Abnormal serum lipid levels have been shown to be associated with the occurrence of atherosclerosis, but little is known about the relationships of them with the risk of developing intervertebral disc degeneration (IVDD) in Chinese population. Methods We performed a case–control study to assess the relationship between serum lipid levels and lumbar disc degeneration. A total of 790 Chinese patients were recruited for this study at the time of hospitalization. We examined fasting serum lipid levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). 396 patients (235 men and 161 women; mean age: 41.07 years) underwent surgery for single-level lumbar disc herniation. A control group of 394 patients (225 men and 169 women; mean age: 42.1 years) underwent surgery for wounded lower limbs during the same period. Patients in the control group were collected randomly from among patients who were age- and sex-matched patients with the case group. Results Patients with lumbar disc herniation had significantly higher TC and LDL-C serum concentrations (P < 0.001 for both) than controls. Percentage of High-TC, High-TG, High-LDL-C, borderline High-TC and borderline High-LDL-C were significantly higher in the disc herniation group (P = 0.017, P = 0.002, P = 0.039, P =0.002 and P < 0.001, respectively). Ratios of TC/HDL-C and LDL-C/HDL-C were significantly associated with disc herniation (P < 0.001 for both). Logistic regression revealed that patients with higher serum LDL-C levels had a higher risk of disc herniation, in which odds ratio (OR) was 1.462 and confidence interval (CI) was 1.179 ~ 1.813. Moreover, patients with High-TG and borderline High-LDL-C had a higher probability of disc herniation (OR: 2.974, CI: 1.488 ~ 5.945, statistical power: 100 %; OR: 1.626, CI: 1.012 ~ 2.612, statistical power: 61.4 %, respectively). However, hyperlipidaemia did not seem to be associated with the herniated segment of the lumbar intervertebral disc (p = 0.374). Conclusions The present study suggests that dyslipidaemia may be associated with a higher risk of developing lumbar disc herniation. Serum lipid levels could be a useful predictor for intervertebral disc degeneration in Chinese population.
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Abstract
BACKGROUND We aimed to identify risk factors associated with chronic low back pain (C-LBP) in Syria. MATERIALS AND METHODS We conducted the study in a busy outpatient neurology clinic in Damascus city from October 2011 to August 2012. We enrolled all eligible adults presenting with C-LBP along with those who denied any back pain as a controls. We considered C-LBP any LBP lasting over 3 months. We developed our own questionnaire. A clinical nurse interviewed each person and filled in the results. RESULTS We had a total of 911 subjects; 513 patients and 398 controls. We found that C-LBP increased with age. Having a sibling with C-LBP was a strong predictor of C-LBP. In women obesity, but not overweight, was a risk factor. Number of children was a risk factor for mothers. Higher level of education decreased the chance of C-LBP in women. Sedentary job increased the risk of C-LBP. CONCLUSION This study sheds some light on risk factors for C-LBP in our population and might help find possible preventive measures.
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Affiliation(s)
- Mohammad Salem Alhalabi
- Department of Neuroscience, Head of Integrated Neuroscience Center, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Hassan Alhaleeb
- Department of Neurology, University of Damascus Faculty of Medicine, Damascus, Syria
| | - Sarah Madani
- Department of Neurology, University of Damascus Faculty of Medicine, Damascus, Syria
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Heuch I, Heuch I, Hagen K, Zwart JA. A Comparison of Anthropometric Measures for Assessing the Association between Body Size and Risk of Chronic Low Back Pain: The HUNT Study. PLoS One 2015; 10:e0141268. [PMID: 26506618 PMCID: PMC4623972 DOI: 10.1371/journal.pone.0141268] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/05/2015] [Indexed: 12/16/2022] Open
Abstract
Background Previous work indicates that overweight and obese individuals carry an increased risk of experiencing chronic low back pain (LBP). It is not known, however, how the association with body size depends on the choice of anthropometric measure used. Objective This work compares relationships with LBP for several measures of body size. Different results may indicate underlying mechanisms for the association between body size and risk of LBP. Methods In a cohort study, baseline information was collected in the community-based HUNT2 (1995–1997) and HUNT3 (2006–2008) surveys in Norway. Participants were 10,059 women and 8725 men aged 30–69 years without LBP, and 3883 women and 2662 men with LBP at baseline. Associations with LBP at end of follow-up were assessed by generalized linear modeling, with adjustment for potential confounders. Results Relationships between waist-hip-ratio and occurrence of LBP at end of follow-up were weak and non-significant after adjustment for age, education, work status, physical activity, smoking, lipid levels and blood pressure. Positive associations with LBP at end of follow-up were all significant for body weight, BMI, waist circumference and hip circumference after similar adjustment, both in women without and with LBP at baseline, and in men without LBP at baseline. After additional mutual adjustment for anthropometric measures, the magnitude of the association with body weight increased in women without LBP at baseline (RR: 1.130 per standard deviation, 95% CI: 0.995–1.284) and in men (RR: 1.124, 95% CI 0.976–1.294), with other measures showing weak associations only. Conclusion Central adiposity is unlikely to play a major role in the etiology of LBP. Total fat mass may be one common factor underlying the associations observed. The association with body weight remaining after mutual adjustment may reflect mechanical or structural components behind the relationship between overweight or obesity and LBP.
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Affiliation(s)
- Ingrid Heuch
- Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Norwegian National Headache Centre, Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - John-Anker Zwart
- Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
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Bae YH, Shin JS, Lee J, Kim MR, Park KB, Cho JH, Ha IH. Association between Hypertension and the Prevalence of Low Back Pain and Osteoarthritis in Koreans: A Cross-Sectional Study. PLoS One 2015; 10:e0138790. [PMID: 26393797 PMCID: PMC4578861 DOI: 10.1371/journal.pone.0138790] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypertension and musculoskeletal disorders are highly prevalent in adult populations. The objective of this study was to investigate the association between hypertension and prevalence of low back pain (LBP) and osteoarthritis in Koreans. METHODS A total 17,128 participants (age ≥20 years) who answered low back pain and osteoarthritis items in the 4th Korean National Health and Nutrition Examination Survey (2007-2009) were analyzed. Odds ratios were calculated using logistic regression and were adjusted for age, sex, income level, education, occupation, BMI, smoking status, alcohol consumption, and physical activity. RESULTS Lifetime prevalence of LBP in hypertensive subjects was 34.4%, and that of osteoarthritis 26.2%. LBP prevalence was significantly lower in hypertensives (fully adjusted OR 0.79; 95% CI 0.70-0.90), and both LBP and osteoarthritis prevalence was significantly lower in participants with systolic blood pressure ≥140mmHg than those with <120mmHg (fully adjusted OR 0.81; 95% CI 0.70-0.94, and 0.81; 95% CI 0.68-0.96, respectively). Prevalence of LBP in subjects with diastolic blood pressure ≥90mmHg was also significantly lower than those with <80mmHg (fully adjusted OR 0.73; 95% CI 0.63-0.85). LBP and osteoarthritis prevalence did not differ by systolic or diastolic blood pressure interval in respondents taking antihypertensive medication. LBP and osteoarthritis prevalence increased with longer hypertension duration (fully adjusted p for trend 0.028, and 0.0008, respectively). CONCLUSIONS Hypertension showed an inverse relationship with LBP and osteoarthritis prevalence, which may be ascribed to hypertension-associated hypalgesia, and antihypertensive medication intake and longer hypertension duration attenuated this association.
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Affiliation(s)
- Young-Hyeon Bae
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Joon-Shik Shin
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jinho Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Me-riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Ki Byung Park
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jae-Heung Cho
- Department of Korean Rehabilitation Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
- * E-mail:
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Heuch I, Heuch I, Hagen K, Zwart JA. Do abnormal serum lipid levels increase the risk of chronic low back pain? The Nord-Trøndelag Health Study. PLoS One 2014; 9:e108227. [PMID: 25233233 PMCID: PMC4169450 DOI: 10.1371/journal.pone.0108227] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 08/27/2014] [Indexed: 12/19/2022] Open
Abstract
Background Cross-sectional studies suggest associations between abnormal lipid levels and prevalence of low back pain (LBP), but it is not known if there is any causal relationship. Objective The objective was to determine, in a population-based prospective cohort study, whether there is any relation between levels of total cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides and the probability of experiencing subsequent chronic (LBP), both among individuals with and without LBP at baseline. Methods Information was collected in the community-based HUNT 2 (1995–1997) and HUNT 3 (2006–2008) surveys of an entire Norwegian county. Participants were 10,151 women and 8731 men aged 30–69 years, not affected by chronic LBP at baseline, and 3902 women and 2666 men with LBP at baseline. Eleven years later the participants indicated whether they currently suffered from chronic LBP. Results Among women without LBP at baseline, HDL cholesterol levels were inversely associated and triglyceride levels positively associated with the risk of chronic LBP at end of follow-up in analyses adjusted for age only. Adjustment for the baseline factors education, work status, physical activity, smoking, blood pressure and in particular BMI largely removed these associations (RR: 0.96, 95% CI: 0.85–1.07 per mmol/l of HDL cholesterol; RR: 1.16, 95% CI: 0.94–1.42 per unit of lg(triglycerides)). Total cholesterol levels showed no associations. In women with LBP at baseline and men without LBP at baseline weaker relationships were observed. In men with LBP at baseline, an inverse association with HDL cholesterol remained after complete adjustment (RR: 0.83, 95% CI: 0.72–0.95 per mmol/l). Conclusion Crude associations between lipid levels and risk of subsequent LBP in individuals without current LBP are mainly caused by confounding with body mass. However, an association with low HDL levels may still remain in men who are already affected and possibly experience a higher pain intensity.
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Affiliation(s)
- Ingrid Heuch
- Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, and Norwegian National Headache Centre, Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - John-Anker Zwart
- Department of Neurology and FORMI, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Ha IH, Lee J, Kim MR, Kim H, Shin JS. The association between the history of cardiovascular diseases and chronic low back pain in South Koreans: a cross-sectional study. PLoS One 2014; 9:e93671. [PMID: 24751659 PMCID: PMC3994023 DOI: 10.1371/journal.pone.0093671] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/08/2014] [Indexed: 11/19/2022] Open
Abstract
Background Cardiovascular disease and related risk factors have been suggested as a mechanism leading to atherosclerosis of the lumbar vessels and consequent lumbar pain or sciatica. But there is continued controversy concerning its generalization. This study examined whether cardiovascular disease or its risk factors were associated with chronic low back pain (cLBP) in Koreans. Methods Health surveys and examinations were conducted on a nationally representative sample (n = 23,632) of Koreans. A total of 13,841 eligible participants (aged 20 to 89 years) were examined to determine the association between cardiovascular disease, the Framingham risk score, major cardiovascular risk factors (blood pressure, diabetes, cholesterol, and smoking habits) and chronic LBP. Results The total prevalence of cLBP was 16.6% (men: 10.8%, women: 21.1%) and that in patients with a history of cardiovascular diseases was 36.6% (men: 26.5%, women: 47.1%). The results showed that patients’ medical history of cardiovascular disease was significantly associated with cLBP in both men and women when adjusted for covariates (men: OR 2.16; 95%CI 1.34∼3.49; women: OR 2.26; 95%CI 1.51∼3.38). No association was observed between cLBP and the Framingham risk score, medication for hyperlipemia, hypertension, diabetes, and major cardiovascular risk factors (systolic blood pressure, total cholesterol, high density lipoprotein cholesterol, triglycerides, glucose and smoking habits) in either men or women. Conclusions The prevalence of cLBP is correlated to a history of cardiovascular disease, but not to the major cardiovascular risk factors from the Framingham study. Further studies on whether these results were affected by psychological factors in patients with a history of cardiovascular diseases or whether new potential risk factors from the artery atherosclerosis hypothesis applying to Koreans exist are needed.
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Affiliation(s)
- In-Hyuk Ha
- Jaseng Medical Foundation, Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
- Graduate School of Public Health & Institute of Health and Environment, Seoul National University, Gwanak-ro, Gwanak-gu, Seoul, Korea
- * E-mail:
| | - Jinho Lee
- Jaseng Medical Foundation, Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
- Department of Herbology, Graduate School of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Me-riong Kim
- Jaseng Medical Foundation, Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Hyejin Kim
- Jaseng Medical Foundation, Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Joon-Shik Shin
- Jaseng Medical Foundation, Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
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Heuch I, Heuch I, Hagen K, Zwart J. Does high blood pressure reduce the risk of chronic low back pain? The Nord-Trøndelag Health Study. Eur J Pain 2013; 18:590-8. [DOI: 10.1002/j.1532-2149.2013.00398.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2013] [Indexed: 01/02/2023]
Affiliation(s)
- I. Heuch
- Department of Neurology and FORMI; Oslo University Hospital; Norway
| | - I. Heuch
- Department of Mathematics; University of Bergen; Norway
| | - K. Hagen
- Department of Neuroscience; Norwegian University of Science and Technology; Trondheim Norway
- Norwegian National Headache Centre; Department of Neurology; St. Olavs Hospital; Trondheim Norway
| | - J.A. Zwart
- Department of Neurology and FORMI; Oslo University Hospital; Norway
- Faculty of Medicine; University of Oslo; Norway
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Relationship between lumbar spinal stenosis and lifestyle-related disorders: a cross-sectional multicenter observational study. Spine (Phila Pa 1976) 2013; 38:E540-5. [PMID: 23380819 DOI: 10.1097/brs.0b013e31828a2517] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional multicenter observational study. OBJECTIVE To identify associations between lumbar spinal stenosis (LSS) and lifestyle-related diseases. SUMMARY OF BACKGROUND DATA Impaired blood flow as a result of arteriosclerosis facilitates degenerative changes in the spine. However, associations between LSS and lifestyle-related diseases (hypertension, diabetes, and dyslipidemia) remain unclear. METHODS Participants comprised 526 patients diagnosed with LSS using the clinical diagnostic support tool and magnetic resonance imaging at 64 facilities. Data on 1218 males and 1636 females in the general population were selected from the 2006 National Health and Nutrition Survey as control data. We investigated the prevalence of lifestyle-related diseases (hypertension, diabetes, and dyslipidemia) and levels of hemoglobin A1c, total cholesterol, and high-density lipoprotein cholesterol. LSS and control groups were divided into 4 subgroups by age (nonelderly, <70 yr old; elderly, ≥ 70 yr) and sex. Statistical analyses were performed to compare patients with LSS and the control group using the χ test or Fisher exact text. Values of P < 0.05 were considered statistically significant. RESULTS Among nonelderly patients, proportions of patients with hypertension and diabetes mellitus were higher in patients with LSS than in controls (P < 0.01 each). The proportion of patients with hemoglobin A1c was 6.1% or greater and higher for female patients with LSS than for female controls (P < 0.05). No significant difference in the proportion of patients with dyslipidemia was apparent between the LSS and control groups. CONCLUSION After adjusting for age and sex, this study revealed a close association between diabetes and hypertension in 50- to 69-year-old patients with LSS. Physicians should consider the possibility of concomitant hypertension or diabetes mellitus when examining 50- to 69-year-old patients with LSS.
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Body mass index as a risk factor for developing chronic low back pain: a follow-up in the Nord-Trøndelag Health Study. Spine (Phila Pa 1976) 2013; 38:133-9. [PMID: 22718225 DOI: 10.1097/brs.0b013e3182647af2] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A population-based, prospective cohort study. OBJECTIVE To determine whether overweight, obesity, or more generally an elevated body mass index (BMI) increase the probability of experiencing chronic low back pain (LBP) after an 11-year period, both among participants with and without LBP at baseline. SUMMARY OF BACKGROUND DATA Chronic LBP is a common disabling disorder in modern society. Cross-sectional studies suggest an association between an elevated BMI and LBP, but it is not clear whether this is a causal relationship. METHODS Data were obtained from the community-based HUNT 2 (1995-1997) and HUNT 3 (2006-2008) studies of an entire Norwegian county. Participants were 8733 men and 10,149 women, aged 30 to 69 years, who did not have chronic LBP at baseline, and 2669 men and 3899 women with LBP at baseline. After 11 years, both groups indicated whether they currently had chronic LBP, defined as pain persisting for at least 3 months continuously during the last year. RESULTS A significant positive association was found between BMI and risk of LBP among persons without LBP at baseline. The odds ratio for BMI 30 or more versus BMI less than 25 was 1.34 (95% confidence interval [CI], 1.08-1.67) for men and 1.22 (95% CI, 1.03-1.46) for women, in analyses adjusted for age, education, work status, physical activity at work and in leisure time, smoking, blood pressure, and serum lipid levels. A significant positive association was also established between BMI and recurrence of LBP among women. LBP status at baseline had negligible influence on subsequent change in BMI. CONCLUSION High values of BMI may predispose to chronic LBP 11 years later, both in individuals with and without LBP. The association between BMI and LBP is not explained by an effect of LBP on later change in BMI.
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Heuch I, Heuch I, Hagen K, Zwart JA. Associations Between Serum Lipid Levels and Chronic Low Back Pain. Epidemiology 2010; 21:837-41. [DOI: 10.1097/ede.0b013e3181f20808] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ramírez CR, Lemus DMC. Disfunção da articulação sacro-ilíaca em jovens com dor lombar. FISIOTERAPIA EM MOVIMENTO 2010. [DOI: 10.1590/s0103-51502010000300009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A dor lombar representa um problema de saúde pública. Estima-se que uma elevada porcentagem de casos de dor lombar (85-90%) não tem uma causa conhecida. Acredita-se que a disfunção da articulação sacro-ilíaca possa explicar, em parte, essa alta porcentagem. OBJETIVO: Determinar a frequência da disfunção da articulação sacro-ilíaca em jovens com dor lombar e descrever possíveis associações com características sócio-demográficas, clínicas e antropométricas da população estudada. METODOLOGIA: A amostra foi selecionada por meio de entrevista direta. Sessenta e sete sujeitos (92,5% mulheres) com idade média de 21 ± 2,1 participaram do estudo. Foi realizado exame físico que incluiu a avaliação da dor à palpação, amplitude de movimento da flexão do quadril, funcionalidade avaliada por meio do Oswestry Disability Index, e realização de quatro provas de provocação de dor da articulação sacro-ilíaca (Gaenslen, thigh thrust, compressão ilíaca e compressão sacra). O diagnóstico para disfunção da articulação sacro-ilíaca foi considerado positivo se pelo menos três das provas foram positivas. RESULTADOS: A frequência de disfunção da articulação sacro-ilíaca foi de 35,8% IC 95% (24,0-47,6). Foi observada associação da disfunção da articulação com diminuição de flexibilidade dos isquiotibiais, pontuação do Oswestry Disability Index e dor à palpação. Não foram encontradas associações estatisticamente significativas com as variáveis sócio-demográficas. CONCLUSÃO: A alta frequência de disfunção da articulação sacro-ilíaca encontrada sugere a possibilidade de detectar e intervir precocemente uma possível causa de dor lombar, evitando alterações funcionais de maior severidade.
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Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol 2010; 171:135-54. [PMID: 20007994 DOI: 10.1093/aje/kwp356] [Citation(s) in RCA: 493] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This meta-analysis assessed the association between overweight/obesity and low back pain. The authors systematically searched the Medline (National Library of Medicine, Bethesda, Maryland) and Embase (Elsevier, Amsterdam, the Netherlands) databases until May 2009. Ninety-five studies were reviewed and 33 included in the meta-analyses. In cross-sectional studies, obesity was associated with increased prevalence of low back pain in the past 12 months (pooled odds ratio (OR) = 1.33, 95% confidence interval (CI): 1.14, 1.54), seeking care for low back pain (OR = 1.56, 95% CI: 1.46, 1.67), and chronic low back pain (OR = 1.43, 95% CI: 1.28, 1.60). Compared with non-overweight people, overweight people had a higher prevalence of low back pain but a lower prevalence of low back pain compared with obese people. In cohort studies, only obesity was associated with increased incidence of low back pain for > or =1 day in the past 12 months (OR = 1.53, 95% CI: 1.22, 1.92). Results remained consistent after adjusting for publication bias and limiting the analyses to studies that controlled for potential confounders. Findings indicate that overweight and obesity increase the risk of low back pain. Overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain.
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Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between smoking and low back pain: a meta-analysis. Am J Med 2010; 123:87.e7-35. [PMID: 20102998 DOI: 10.1016/j.amjmed.2009.05.028] [Citation(s) in RCA: 356] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 05/18/2009] [Accepted: 05/20/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the association between smoking and low back pain with meta-analysis. METHODS We conducted a systematic search of the MEDLINE and EMBASE databases until February 2009. Eighty-one studies were reviewed and 40 (27 cross-sectional and 13 cohort) studies were included in the meta-analyses. RESULTS In cross-sectional studies, current smoking was associated with increased prevalence of low back pain in the past month (pooled odds ratio [OR] 1.30, 95% confidence interval [CI], 1.16-1.45), low back pain in the past 12 months (OR 1.33, 95% CI, 1.26-1.41), seeking care for low back pain (OR 1.49, 95% CI, 1.38-1.60), chronic low back pain (OR 1.79, 95% CI, 1.27-2.50) and disabling low back pain (OR 2.14, 95% CI, 1.11-4.13). Former smokers had a higher prevalence of low back pain compared with never smokers, but a lower prevalence of low back pain than current smokers. In cohort studies, both former (OR 1.32, 95% CI, 0.99-1.77) and current (OR 1.31, 95% CI, 1.11-1.55) smokers had an increased incidence of low back pain compared with never smokers. The association between current smoking and the incidence of low back pain was stronger in adolescents (OR 1.82, 95% CI, 1.42-2.33) than in adults (OR 1.16, 95% CI, 1.02-1.32). CONCLUSIONS Our findings indicate that both current and former smokers have a higher prevalence and incidence of low back pain than never smokers, but the association is fairly modest. The association between current smoking and the incidence of low back pain is stronger in adolescents than in adults.
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Affiliation(s)
- Rahman Shiri
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
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Vaez M, Hagberg J, Alexanderson K. The panorama of future sick-leave diagnoses among young adults initially long-term sickness absent due to neck, shoulder, or back diagnoses. An 11-year prospective cohort study. BMC Musculoskelet Disord 2009. [PMCID: PMC2719585 DOI: 10.1186/1471-2474-10-84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kauppila L. Atherosclerosis and Disc Degeneration/Low-Back Pain – A Systematic Review. Eur J Vasc Endovasc Surg 2009; 37:661-70. [DOI: 10.1016/j.ejvs.2009.02.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 02/17/2009] [Indexed: 10/21/2022]
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Leino-Arjas P, Kauppila L, Kaila-Kangas L, Shiri R, Heistaro S, Heliövaara M. Serum lipids in relation to sciatica among Finns. Atherosclerosis 2008; 197:43-9. [PMID: 17825307 DOI: 10.1016/j.atherosclerosis.2007.07.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 07/30/2007] [Accepted: 07/31/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Atherosclerosis of arteries supplying the lumbar region has been suggested as a mechanism leading to intervertebral disc degeneration and sciatica. The study described here examined whether serum lipid levels or pharmacologically treated hyperlipidemia were associated with sciatica. METHODS A nationally representative sample (n=8028) of Finns aged 30 years or over was interviewed and examined. Sciatica was assessed by a physician according to preset criteria. Information for the present purpose was available for 74.8% of the sample. RESULTS The prevalence of sciatica was 3.3% for men and 2.2% for women. In men without hyperlipidemia treatment, sciatica was associated with total cholesterol (high vs. low tertile: OR 2.28, 95% CI 1.14-4.55), LDL cholesterol (2.12; 1.11-4.05), and triglycerides (1.92; 1.04-3.55), adjusted for age, BMI, exercise, smoking, heavy physical work, and education. HDL was not associated with sciatica. For men in the highest tertile of both total cholesterol and triglycerides, the OR of sciatica was 3.89 (1.68-8.99) in comparison to men with cholesterol in the lowest tertile and triglycerides in the lowest or the middle tertile. In similar analyses among women no associations were seen. Pharmacologically treated hyperlipidemia was associated with sciatica in women (2.02; 1.01-4.04), but not in men (1.71; 0.83-3.55). CONCLUSIONS Independent of BMI and other possible confounders, clinically assessed sciatica in men was associated with levels of atherogenic serum lipids. Pharmacologically treated hyperlipidemia was associated with sciatica in women. The findings are in accordance with the atherosclerosis-sciatica hypothesis.
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Affiliation(s)
- Päivi Leino-Arjas
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FIN-00250 Helsinki, Finland.
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Leino-Arjas P, Kaila-Kangas L, Solovieva S, Riihimäki H, Kirjonen J, Reunanen A. Serum lipids and low back pain: an association? A follow-up study of a working population sample. Spine (Phila Pa 1976) 2006; 31:1032-7. [PMID: 16641781 DOI: 10.1097/01.brs.0000214889.31505.08] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cohort study with 5-, 10-, and 28-year follow-up. OBJECTIVES To examine associations between baseline serum lipid concentrations and later low back pain (LBP). SUMMARY OF BACKGROUND DATA Atherosclerosis of the lumbar vessels has been suggested as a mechanism leading to disc degeneration and LBP. Cholesterol is considered essential for atherosclerosis development. METHODS A sample (n = 902) of employees in an engineering company was examined for serum total cholesterol and triglycerides, body mass index (BMI), smoking, exercise, work history, and LBP in 1973. By November 2000, 232 subjects had died. In 1978, 748 (84% of the survivors), in 1983, 654 (76%), and in 2000, 546 (81%) responded to a follow-up questionnaire. RESULTS In men, baseline serum total cholesterol predicted new cases of radiating LBP in the 5-year follow-up (highest tertile vs. lowest: odds ratio [OR], 2.5; 95% confidence interval [CI], 1.1-5.9) and in the 10-year follow-up (OR, 2.8; 95% CI, 1.3-6.1), adjusted for age, occupational class, work history, BMI, smoking and exercise. Also, serum triglycerides predicted new cases in the latter examination (OR, 2.6; 95% CI, 1.2-5.8). In women, no associations were seen until the 10-year follow-up, when their results were similar to those in men. In the total material, serum total cholesterol predicted radiating LBP reported both at the 10- and the 28-year follow-up. CONCLUSIONS High serum lipids predicted incident radiating LBP, consistent with the atherosclerosis-LBP hypothesis.
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Affiliation(s)
- Päivi Leino-Arjas
- Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, Helsinki, Finland.
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Kauppila LI, Mikkonen R, Mankinen P, Pelto-Vasenius K, Mäenpää I. MR aortography and serum cholesterol levels in patients with long-term nonspecific lower back pain. Spine (Phila Pa 1976) 2004; 29:2147-52. [PMID: 15454707 DOI: 10.1097/01.brs.0000141168.77393.b8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional analysis of the feeding arteries of the lumbar spine and cholesterol levels on patients with long-term nonspecific lower back pain. OBJECTIVES To evaluate whether occlusion of lumbar and middle sacral arteries or serum cholesterol levels are associated with lower back pain and/or with disc degeneration. SUMMARY OF BACKGROUND DATA Atherosclerosis in the wall of the abdominal aorta usually develops at the ostia of branching arteries and the bifurcation, and may obliterate orifices of lumbar and middle sacral arteries. Obstruction of these arteries causes ischemia in the lumbar spine and may result in back symptoms and disc degeneration. METHODS MR aortography and cholesterol blood tests were performed on 51 patients with long-term lower back pain without specific findings (i.e., spinal or nerve root compression) in regular lumbar MR images. The patients ranged from 35 to 70 years of age (mean age, 56 years). Serum cholesterol and low-density lipoprotein (LDL) cholesterol levels were measured. To assess symptoms and disability NASS low back Outcome Instrument was used. RESULTS Twenty-nine (78%) of 37 men and 11 (77%) of 14 women showed occluded lumbar and/or middle sacral arteries. The prevalence of occluded arteries was 2.5 times more than in subjects of corresponding age group in a Finnish necropsy material. Twenty-three (62%) men and seven (50%) women had significant disc degeneration. Disc degeneration was associated with occluded lumbar/middle sacral arteries (P = 0.035). Patients with occluded arteries or significant disc degeneration did not complain more severe symptoms than those without, whereas patients with above normal serum LDL cholesterol scored higher in neurogenic symptoms (P = 0.031) and complained more often severe pain (P = 0.049) than those with normal LDL cholesterol. CONCLUSIONS The study indicates that lumbar and middle sacral arteries are often occluded in patients with nonspecific long-term lower back pain. Occlusion of these arteries may also be associated with disc degeneration.
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Affiliation(s)
- Leena I Kauppila
- Departments of Rehabilitation, Helsinki University Central Hospital, Jorvi Hospital, Espoo, Finland.
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Kivimäki M, Vahtera J, Ferrie JE, Hemingway H, Pentti J. Organisational downsizing and musculoskeletal problems in employees: a prospective study. Occup Environ Med 2001; 58:811-7. [PMID: 11706148 PMCID: PMC1740075 DOI: 10.1136/oem.58.12.811] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To study the association between organisational downsizing and subsequent musculoskeletal problems in employees and to determine the association with changes in psychosocial and behavioural risk factors. METHODS Participants were 764 municipal employees working in Raisio, Finland before and after an organisational downsizing carried out between 1991 and 1993. The outcome measures were self reports of severity and sites of musculoskeletal pain at the end of 1993 and medically certified musculoskeletal sickness absence for 1993-5. The contribution of changes in psychosocial work characteristics and health related behaviour between the 1990 and 1993 surveys was assessed by adjustment. RESULTS After adjustment for age, sex, and income, the odds ratio (OR) for severe musculoskeletal pain between major and minor downsizing and the corresponding rate ratios for musculoskeletal sickness absence were 2.59 (95% confidence interval (95% CI) 1.5 to 4.5) and 5.50 (3.6 to 7.6), respectively. Differences between the mean number of sites of pain after major and minor downsizing was 0.99 (0.4 to 1.6). The largest contribution from changes in work characteristics and health related behaviour to the association between downsizing and musculoskeletal problems was from increases in physical demands, particularly in women and low income employees. Additional contributory factors were reduction of skill discretion (relative to musculoskeletal pain) and job insecurity. The results were little different when analyses were confined to initially healthy participants. CONCLUSIONS Downsizing is a risk factor for musculoskeletal problems among those who remain in employment. Much of this risk is attributable to increased physical demands, but adverse changes in other psychosocial factors may also play a part.
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Affiliation(s)
- M Kivimäki
- Department of Psychology, PO Box 13, FIN 00014, University of Helsinki, Finland.
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Abstract
Differences in the health of individuals reflect inherent features of the societies in which they live. The way a society organizes itself and delivers wellbeing to its members are major determinants of health. Social, economic and political factors have an important influence on health and longevity. Social position and lifestyle only partially explain ill health. Psychosocial factors, such as a sense of isolation, deprivation or loss of control, are also important. Governments can reduce health inequalities by ensuring that all policies are assessed for their potential impact on the health of all sectors of society.
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Affiliation(s)
- M Marmot
- Department of Epidemiology and Public Health, Royal Free and University College London Medical School, UK.
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Abstract
An association between obesity and back pain has been observed, but the underlying causal direction is uncertain. We examined the temporal sequence among back pain, BMI, and weight gain using data from the 1958 British birth cohort followed to age 33 (4395 men and 4468 women). Heights and weights were measured at ages 7 and 33, and self-reported at age 23. Back pain was classified as: chronic, incident, early onset but recovered, and never. Those with chronic pain gained more weight between ages 23 and 33 than those with no pain, significantly for women (7.39 kg vs. 6.29 kg). Women who were obese at age 23 years had an elevated risk of subsequent back pain onset (32-33 years) (adjusted OR = 1.78). No significant relationships were found for men. The risk of pain onset among women was evident in relation to BMI at baseline (age 23) and cannot therefore be explained by an effect of back pain on adiposity.
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Affiliation(s)
- J K Lake
- Department of Epidemiology & Public Health, Institute of Child Health, 30 Guilford Street, London, UK
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