PREVALENCE OF SELF-REPORTED SPINAL PAIN IN BRAZIL: RESULTS OF THE NATIONAL HEALTH RESEARCH

Low back pain should be considered a health and research priority in Brazil: Lost productivity and healthcare costs between 2012 to 2016

BACKGROUND

Low Back Pain (LBP) is associated with an increase in disability-adjusted life years, and increased risk of disability retirement and greater absenteeism in Brazil. Hence, evidence on healthcare and lost productivity costs due to LBP is of utmost importance to inform decision-makers.

METHODS

Cost-of-illness study with top-down approach, and societal perspective. We extracted data from National databases, considering the period 2012-2016. Outpatient expenses included clinical, surgical, diagnosis, orthosis/prosthetics, and complementary actions. Inpatient care expenses included hospital and professional services, intensive care unit, and companion stay. For productivity losses, duration of work absence and associated information (work-related and non-work-related; value of the sickness absence benefit; age; gender; and economic activity) were analyzed. Lost productivity costs were calculated multiplying the absence from work (days) by the daily-benefit.

RESULTS

The societal costs amounted to US$ 2.2 billion, and productivity losses represented 79% of the costs. Total healthcare expenses were estimated to US$ 460 million. We found more than 880,000 diagnostic images. Individuals with LBP were in total 59 million days absent from work between 2012-2016. The mean lost days absent from work per person, for each year investigated was, respectively, 88; 84; 83; 87; and 100. Men were more days absent from work than women. In addition, rural workers presented greater absence from work compared to other professional activities.

CONCLUSION

Healthcare expenses and lost productivity costs due to LBP were substantial, hence, there is a need for improvement of health services and policies to deal with this increasing burden of illness. We found an extensive use of diagnostic imaging, which is rather discouraged by clinical guidelines. We assume that men were experiencing high levels of back pain disability compared with women, as they presented greater absenteeism and higher lost productivity costs.

CLASSIFICATION OF LOW BACK PAIN INTO SUBGROUPS FOR DIAGNOSTIC AND THERAPEUTIC CLARITY

ABSTRACT Objective To establish a classification in subgroups with symptoms and functionality involving volunteers with nonspecific chronic low back pain for better clarity of functional and therapeutic diagnostic definitions. Methods Observational, quantitative, cross-sectional study with population of 62 university students between 18 and 30 years of age, with a mean age of 21.40 (± 2.40) years, presenting nonspecific lumbar pain for more than three months. Three questionnaires were used for the division into subgroups: STarT Back Screening, the Oswestry Disability Index, and FABQ-Brasil, the VAS evaluation, orthopedic tests: Lasègue’s, Slump test, de Sèze test, Valsalva maneuver, and evaluation of the pain threshold of the right and left iliocostal lumbar muscles. Results All the volunteers included in the study had chronic back pain. Most of them (50%) had normal body mass index, 54.8% were sedentary, and of those who were physically active, 14.5% did body building. The Slump test (35.5%) proved to be more reliable than Lasègue’s test (21%). In the evaluation, the volunteers reported moderate pain intensity (72.6%) and the mean pressure pain threshold was 6.37 kgf and 6.14 kgf for the right and left iliocostal muscles, respectively. In the questionnaires, 85.5% had a low-risk score, that is, a good prognosis for pain treatment, and 91.9% had minimum disability. The largest treatment hypothesis group was stabilization (29.0%). Conclusion The method of treatment subgroup classification is a guide towards better semiological perspectives and the definition of the clinically preferred physiotherapeutic treatment for each case. Level of Evidence III; Diagnostic study.

Analgesic use among the Brazilian population: Results from the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM)

Purpose

To estimate the prevalence of use of analgesics in Brazil; and to characterize this use, according to sociodemographic and health-related characteristics.

Methods

A cross-sectional population-based study (National Survey on Access, Use and Promotion of Rational Use of Medicines, PNAUM) was conducted between September 2013 and February 2014. A total of 41,433 people of all ages in Brazilian urban households were interviewed. Occasional use (within the last 15 days) and continuous use of non-opioid analgesics, opioid analgesics and non-steroidal anti-inflammatory drugs were investigated, regardless of whether this use occurred through prescription or self-medication. The main outcome was the use of at least one analgesic.

Results

The majority of the individuals were female (52.8%), aged between 20 and 59 years (57.2%), with 1 to 8 years of schooling (45.6%). The overall prevalence of analgesic use was 22.8% [95% CI: 21.4–24.2]. The use of analgesics was significantly higher among women, adults and elderly (20 years or more), highly educated individuals and respondents who referred: diagnosis of one or more chronic diseases, using three or more medications, possession of health insurance and with one or more emergency care admittances or hospitalizations within the last year. Non-opioid analgesics were the agents most used (18.5% of the sample), followed by non-steroidal anti-inflammatory drugs (6.9%) and opioid analgesics (0.5%). The most commonly used drugs were metamizole (37.8% of all analgesics), paracetamol (25.3%) and diclofenac (10.7%). These drugs were used mainly to manage occasional health conditions, particularly pain.

Conclusion

One in five Brazilians used some analgesic, especially non-opioid analgesics, to manage acute health problems such as painful conditions.