Prevalence of chronic low back pain: systematic review

Meucci, Rodrigo Dalke; Fassa, Anaclaudia Gastal; Faria, Neice Muller Xavier

doi:10.1590/S0034-8910.2015049005874

Brasil

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Revisão • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005874 linkcopy

Prevalence of chronic low back pain: systematic review

Prevalência de dor lombar crônica: revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE To estimate worldwide prevalence of chronic low back pain according to age and sex.

METHODS We consulted Medline (PubMed), LILACS and EMBASE electronic databases. The search strategy used the following descriptors and combinations: back pain, prevalence, musculoskeletal diseases, chronic musculoskeletal pain, rheumatic, low back pain, musculoskeletal disorders and chronic low back pain. We selected cross-sectional population-based or cohort studies that assessed chronic low back pain as an outcome. We also assessed the quality of the selected studies as well as the chronic low back pain prevalence according to age and sex.

RESULTS The review included 28 studies. Based on our qualitative evaluation, around one third of the studies had low scores, mainly due to high non-response rates. Chronic low back pain prevalence was 4.2% in individuals aged between 24 and 39 years old and 19.6% in those aged between 20 and 59. Of nine studies with individuals aged 18 and above, six reported chronic low back pain between 3.9% and 10.2% and three, prevalence between 13.1% and 20.3%. In the Brazilian older population, chronic low back pain prevalence was 25.4%.

CONCLUSIONS Chronic low back pain prevalence increases linearly from the third decade of life on, until the 60 years of age, being more prevalent in women. Methodological approaches aiming to reduce high heterogeneity in case definitions of chronic low back pain are essential to consistency and comparative analysis between studies. A standard chronic low back pain definition should include the precise description of the anatomical area, pain duration and limitation level.

Low Back Pain, epidemiology; Pain Measurement; Prevalence; Review

Author (year)	Country	Design	Response rate	N	Male		Female		Age or age group	Definition of chronic pain	Prevalence	95%CI
Author (year)	Country	Design	%	N	n	%	n	%	Age or age group	Definition of chronic pain	%	95%CI
Hoddevik et al²⁰ (1999)	Norway	CS	63.4	67,338	31,846	47.3	35,492	52.7	40-42	> 3 months	2.0	1.9;2.1
Shiri et al³⁸ (2008)	Finland	CS	76.0	2,575	1,185	46.0	1,390	54.0	24-39	Continuous pain in the last year	4.2	3.4;5.0
Picavet et al³⁶ (2000)	Netherlands	CS	50.0	22,415	10,132	45.2	12,283	54.8	20-59	> 3 months	19.1	18.6;19.6
Palmer et al³⁴ (2005)	England	CS	53.0	2,632	Not reported	Not reported	Not reported	Not reported	25-64	> 6 months	11.0	9.8;12.2
Hillman et al¹⁹ (1996)	England	CS	72.0	3,184	1,437	45.1	1,747	54.9	25-64	> 3 months	10.2	9.1;11.3
Alkherayf et al¹ (2009)	Canada	CS	78.9	73,507	35,242	47.9	38,265	52.1	20-59	Continuous pain > 6 months	19.6	19.3;19.9
Picavet et al³⁷ (2003)	Netherlands	CS	50.0	3,664	1,640	44.8	2,024	55.2	≥ 25	> 3 months	21.2	19.9;22.5
Heuch et al¹⁸ (2010a)	Norway	CS	69.0	63,968	30,102	47.1	33,866	52.9	≥ 20	> 3 months	23.6	23.3;23.9
Bjorck-Van Dijken et al⁶ (2008)	Sweden	CS	69.3	5,798	Not reported	Not reported	Not reported	Not reported	25-79	> 6 months	16.4	15.5;17.4
Johannes et al²⁴ (2010)	USA	CS	75.7	27,035	10,357	38.3	16,678	61.7	≥ 18	> 6 months	8.1	7.5;8.7
Carey et al⁸ (1995)	USA	CS	79.0	8,067	Not reported	Not reported	Not reported	Not reported	≥ 21	> 3 months/or 24 episodes of pain in the last year	3.9	3.5;4.3
Freburger et al¹⁴ (2009)	USA	CS	86.0	9,924	Not reported	Not reported	Not reported	Not reported	≥ 21	> 3 months/or 24 episodes of pain in the last year	10.2	9.6;10.8
Meucci et al²⁹ (2013)	Brazil (Pelotas)	CS	89.6	2,732	1,151	42.1	1,581	57.9	≥ 20	≥ 7 weeks in the last 3 months	9.6	8.3;10.8
Andersson⁵ (1994)	Sweden	CS	90.0	1,609	817	50.8	792	49.2	25-74	> 3 months	23.3	21.2;25.4
Silva et al³⁹ (2004)	Brazil (Pelotas)	CS	94.4	3,182	1,374	43.2	1,808	56.8	≥ 20	≥ 7 weeks in the last 3 months	4.2	3.5;5.0
Almeida et al² (2008)	Brazil (Salvador)	CS	97.1	2,281	1,016	44.5	1,265	55.5	≥ 20	Continuous pain > 6 months	14.7	13.3;16.2
Dellaroza et al⁹ (2013)	Brazil (Sao Paulo)	CS	89.9	1,271	513	40.4	758	59.6	≥ 60	Continuous pain > 6 months	25.4	23.0;27.8
Omokhodion³¹ (2002)	Nigeria	CS	100	900	450	50.0	450	50.0	20-85	> 3 months	7.0	5.3;8.7
Brattberg et al⁷ (1989)	Sweden	CS	82.0	857	391	47.3	436	52.7	18-84	> 6 months	20.3	17.6;23.0
Altinel et al³ (2008)	Turkey	CS	100	2,035	841	41.3	1,194	58.7	≥ 19	Continuous pain	13.1	11.6;14.6
Park et al³⁵ (1993)	USA	CS	87.0	44,233	18,562	42.0	25,671	58.0	≥ 18	> 3 months	6.7	6.4;7.0
Fujii et al¹⁵ (2012)	Japan	CS	Not reported	52,650	26,779	50.9	25,871	49.1	20-79	4^th degree low back pain lasting > 3 months at some time in life	3.9	3.7;4.1
Jacobsson et al²² (1989)	Sweden	CS	49.4	445	230	51.7	215	48.3	50-69	Pain > 6 weeks Rheumatologist's diagnosis	6.3	4.0;8.6
Liao et al²⁶ (2009)	China	CS	88.7	10,921	5,687	52.1	5,234	47.9	≥ 16	> 3 months	1.0	0.8;1.2
Jimenez-Sanchez et al²³ (2012)	Spain	CS	Not reported	12,190	5,742	47.1	6,448	52.9	≥ 16	> 3 months	11.1	10.5;11.7
Hagen et al¹⁶ (2011)	Norway	C	HUNT 2: 53.0	49,483	Not reported	Not reported	Not reported	Not reported	≥ 20	> 3 months	–	–
			HUNT 3: 54.0	50,839							HUNT 2: 22.7	22.4;23.0
			Wave II:90 WI	1,671							HUNT 3: 23.4	23.0;23.9
Van Oostrom et al³² (2011)	Netherlands	C	Baseline: 62.0	12,405	2,686	47.1	3,020	52.9	26-65	> 3 months or "pain always present" Definitions changed during follow-ups T1-T2	Follow-up I: 17.4%
			Follow-up I: 79.0	6,118							Follow-up II: 17.4%
			Follow-up II: 75.0	4,917							Follow-up III: 19.9%
			Follow-up III: 78.0	4,520							Incidence: No/No/No: 62.4% No/Yes/Yes or No/No/Yes: 10.8%
			For analyses with data from all follow-ups	5,706							Recurrence/Persistence: Yes/Yes/No or Yes/No/No: 10.3% Yes/No/Yes or No/Yes/No: 10.9% Yes/Yes/Yes: 5.6%
Waxman et al⁴⁰ (2000)	England	C	Baseline: 76.0	3,184	–		–		25-64	> 3 months	Baseline: 6.3% Follow-up: 11.1%
Waxman et al⁴⁰ (2000)	England	C	Follow up: 70.0	1,455	615		840		25-64	> 3 months	Baseline: 6.3% Follow-up: 11.1%

Study	Score weight								Total score
	0.2	0.08	0.2	0.2	0.08	0.08	0.08	0.08

	Was the sampling frame a true or close representation of the target population?	Was the sample size estimated?	Was some form of random selection used to select the sample, OR, was a census undertaken?	Was the likelihood of non-response bias minimal?	Were data collected directly from the subjects (as opposed to a proxy)?	Had the study instrument that measured the parameter of interest (e.g., CLBP prevalence) been tested for reliability and validity (if necessary)?	Was data collection standard ized?	Was a human body drawing used?
Hoddevik et al²⁰ (1999)	Yes	No	Yes	No	Yes	No	Yes	No	0.56
Shiri et al³⁸ (2008)	Yes	No	Yes	Yes	Yes	No	Yes	Yes	0.84
Picavet et al³⁶ (2000)	Yes	No	Yes	No	Yes	No	Yes	Yes	0.64
Palmer et al³⁴ (2005)	Yes	No	Yes	No	Yes	No	Yes	No	0.56
Hillman et al¹⁹ (1996)	Yes	No	Yes	No	Yes	Yes	Yes	Yes	0.72
Alkherayf et al¹ (2009)	Yes	No	Yes	Yes	Yes	No	Yes	No	0.76
Picavet et al³⁷ (2003)	Yes	No	Yes	No	Yes	No	Yes	Yes	0.64
Heuch et al¹⁸ (2010a)	Yes	No	Yes	No	Yes	No	Yes	No	0.56
Bjorck-Van Dijken et al⁶ (2008)	Yes	No	Yes	No	Yes	No	Yes	No	0.56
Johannes et al²⁴ (2010)	Yes	No	Yes	No	Yes	No	Yes	No	0.76
Carey et al⁸ (1995)	Yes	No	Yes	Yes	Yes	No	Yes	No	0.76
Freburger et al¹⁴ (2009)	Yes	No	Yes	Yes	Yes	No	Yes	No	0.76
Meucci et al²⁹ (2013)	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	0.92
Andersson⁵ (1994)	Yes	No	Yes	Yes	Yes	Yes	Yes	Yes	0.92
Silva et al³⁹ (2004)	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	0.92
Almeida et al² (2008)	Yes	Yes	Yes	Yes	Yes	No	Yes	No	0.84
Dellaroza et al⁹ (2013)	Yes	No	Yes	Yes	Yes	No	Yes	No	0.76
Omokhodion³¹ (2002)	Yes	No	Yes	Yes	Yes	No	Yes	Yes	084
Brattberg et al⁷ (1989)	Yes	No	Yes	Yes	Yes	No	Yes	No	0.76
Altinel et al³ (2008)	Yes	Yes	Yes	Yes	Yes	No	Yes	No	0.84
Park et al³⁵ (1993)	Yes	No	Yes	Yes	Yes	No	Yes	No	0.76
Fujii et al¹⁵ (2012)	Yes	No	Yes	Yes	Yes	No	Yes	Yes	0.84
Jacobsson et al²² (1989)	Yes	No	Yes	No	Yes	No	Yes	No	0.56
Liao et al²⁶ (2009)	Yes	No	Yes	Yes	Yes	No	Yes	No	0.76
Jimenez-Sanchez et al²³ (2012)	Yes	No	Yes	Yes	Yes	No	Yes	No	0.76
Hagen et al¹⁶ (2011)	Yes	No	Yes	Yes	Yes	Yes	Yes	No	0.64
Van Oostrom et al³² (2011)	Yes	No	Yes	Yes	Yes	No	Yes	No	0.76
Waxman et al⁴⁰ (2000)	Yes	No	Yes	Yes	Yes	No	Yes	Yes	0.84

Author (year)	Variable	Prevalence
Author (year)	Variable	%	95%CI	%	95%CI
Alkherayf et al¹ (2009)	Smoking status	Daily smokers (present or former): 23.3 Occasional smokers (present or former): 17.2 Non-smokers: 15.7 Analysis stratified by smoking status: CLBP prevalence was higher in daily smokers (present or former) in comparison to occasional smokers (present or former) and non-smokers in all variables assessed: sex, age, BMI, education and occupational status

Freburger et al¹⁴ (2009)	Race/Ethnicity	1992		2006
		Non-Hispanic white: 4.1	3.5;4.7	Non-Hispanic white: 10.5	9.4;11.5
		Non-Hispanic black: 3.0	2.0;4.0	Non-Hispanic black: 9.8	8.2;11.4
		Other:4.1	1.4;6.8	Hispanic: 6.3	3.8;8.9
				Other: 9.1	6.2;12.0

Meucci et al²⁹ (2013) & Silva et al³⁹ (2004)	Education (years)	2002		2010
		0: 6.9	6.0;7.8	0: 14.3	9.7;18.9
		1-4: 6.3	5.5;7.2	1-4: 13.0	10.2;15.7
		5-8: 4.4	3.7;5.2	5-8: 9.7	7.5;11.9
		9-11: 2.7	2.2;3.3	9-11: 8.1	5.9;10.2
		≥ 12: 2.0	1.5;2.6	≥ 12: 6.8	4.7;8.8
	Economic status	A or B: 2.8	2.3;3.4	A or B: 7.8	5.0;10.5
		C: 4.6	3.9;5.4	C: 9.0	7.4;10.5
		D or E: 4.6	3.9;5.4	D or E: 11.3	9.0;13.6
	Smoking	Never: 3.2	2.6;3.9	Never: 8.0	6.6;9.4
		Former smoker: 5.0	4.3;5.8	Former smoker: 11.3	8.5;14.1
		Smoker: 5.5	4.7;6.3	Smoker: 11.5	9.2;13.9
	BMI (kg/m²)	≤ 19.9: 2.7	2.1;3.3	≤ 19.9: 4.3	0.5;8.0
		20-24.9: 3.4	2.8;4.1	20-24.9: 8.0	6.1;9.8
		25-29.9: 4.1	3.4;4.9	25-29.9: 8.4	6.5;10.2
		≥ 30.0: 6.2	5.7;7.1	≥ 30.0: 14.2	11.5;16.9

Almeida et al² (2008)	Smoking	Never: 12.2
		Former smoker: 19.7
		Smoker: 17.6
	Marital status	Married or partner: 15.9
		Single: 9.5
		Widow or divorced: 20.6

Fujii¹⁵ (2012)	Smoking	No CLBP		CLBP
	Smoking	Ever smoked: 52.4		Ever smoked: 42.6
	Education	College: 49.4		College: 40.8

Jimenez-Sanchez et al²³ (2012)	Education	Male		Female
		No studies: 9.7	6.9;13.5	No studies: 20.1	16.7;24.0
		Primary: 9.9	8.7;11.2	Primary: 17.1	15.7;18.6
		Secondary:6.6	5.4;7.9	Secondary: 10.7	9.3;12.3
	Marital status	Single: 4.3	3.4;5.4	Single: 7.7	6.5;9.1
		Married: 9.5	8.6;10.6	Married: 15.5	14.3;16.8
		Divorced or widowed: 10.5	7.2;15.1	Divorced or widowed: 20.4	18.0;23.0

Van Oostromet al³² (2011)		Analysis stratified by 3 patterns of low back pain: never long-standing LBP; persistent LBP over 10 years; varying LBP. Individuals with persistent LBP were less educated, have less paid job, were more obese, and predominantly smokers.

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[TFN1] CS: cross-sectional; C: cohort; HUNT: Nord-Trøndelag Health Study