The emerging Burden of Low Back Pain in the Iranian Population: A Warning About Resource Limitations

authors:

avatar Masood Mohseni ORCID 1 , * , avatar Farnad Imani ORCID 1

Pain Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

how to cite: Mohseni M, Imani F. The emerging Burden of Low Back Pain in the Iranian Population: A Warning About Resource Limitations. Interv Pain Med Neuromod. 2023;3(1):e136055. https://doi.org/10.5812/ipmn-136055.

Dear Editor,

Low back pain (LBP) is the leading cause of disability and an economic burden worldwide. Only a few percent of patients could find a certain physical pathology, such as infection, tumor invasion, or vertebral fracture. The interaction of physical, psychological, and social stimuli can best explain LBP (1). Studies have shown that two triggers lead to an unexpected increase in the incidence of back pain in the community: natural disasters and economic decline (2, 3). There is strong evidence that poor socioeconomic status (SES) is associated with LBP, its chronicity, and accompanying disability (4). Among the economic variables, the unemployment rate is significantly related to the incidence of back pain (5).

The statistics of the International Monetary Fund on Iran's economy show an almost zero percent growth rate in the last decade and predict lower economic growth in 2023. Global growth will slow down, and the unemployment rate will predictably increase (6). These data, with accompanying emotional stress caused by job insecurity, predispose society to the burden of SES-related health problems, namely LBP. We, clinicians, must play our part in managing this public health problem and economic burden.

Health care utilization and related costs and disability due to low back pain vary substantially between countries and are influenced by social systems and local culture as well as beliefs about cause and effect. There are wrong beliefs contrary to the scientific evidence in clinicians and patients. In addition, the worry of being sued by patients leads to unnecessary diagnostic and therapeutic measures. For instance, limited evidence supports the clinical utility of radiologic or electrodiagnostic studies in acute or subacute LBP or the long-term benefit of medication or steroid injection for nonspecific low back pain. Most patients have a misconception about the benefits of extended rest for back pain. Correcting these misbehaviors and replacing them with evidence-based treatment strategies is even more important in low-income countries, where the health system is often fragile and not equipped to cope with this growing burden.

Cochrane systematic reviews suggest that after excluding red flag signs and symptoms, it would be reasonable to prescribe more feasible therapeutic modalities such as exercise therapy, including core strengthening (7), acupuncture treatment (8), and early return to work with necessary workplace modifications (9). An early assessment is useful for barriers to recovery, such as fear-avoidance beliefs and psychosocial factors (10). To establish this practice, health policymakers should develop a national guideline with the help of a multidisciplinary team of experts. Physicians should receive more legal protection against complaints contrary to clinical guidelines, and finally, more work needs to be done on people's beliefs about back pain in the reference media. These measures do not reduce the government's responsibility to create economic prosperity and employment. Clinicians warn about the outlook and perform their daily practices as best as possible within the existing structure.

References

  • 1.

    Marin TJ, Van Eerd D, Irvin E, Couban R, Koes BW, Malmivaara A, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain. Cochrane Database Syst Rev. 2017;6(6):CD002193. [PubMed ID: 28656659]. [PubMed Central ID: PMC6481490]. https://doi.org/10.1002/14651858.CD002193.pub2.

  • 2.

    Angeletti C, Guetti C, Ursini ML, Taylor Jr R, Papola R, Petrucci E, et al. Low back pain in a natural disaster. Pain Pract. 2014;14(2):E8-16. [PubMed ID: 23763663]. https://doi.org/10.1111/papr.12087.

  • 3.

    Yabe Y, Hagiwara Y, Sekiguchi T, Sugawara Y, Sato M, Kanazawa K, et al. Influence of living environment and subjective economic hardship on new-onset of low back pain for survivors of the Great East Japan Earthquake. J Orthop Sci. 2017;22(1):43-9. [PubMed ID: 27884501]. https://doi.org/10.1016/j.jos.2016.11.003.

  • 4.

    Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21-4. [PubMed ID: 16595438]. https://doi.org/10.2106/JBJS.E.01273.

  • 5.

    Ikeda T, Sugiyama K, Aida J, Tsuboya T, Osaka K. The Contextual Effect of Area-Level Unemployment Rate on Lower Back Pain: A Multilevel Analysis of Three Consecutive Surveys of 962,586 Workers in Japan. Int J Environ Res Public Health. 2019;16(20):4016. [PubMed ID: 31635154]. [PubMed Central ID: PMC6843957]. https://doi.org/10.3390/ijerph16204016.

  • 6.

    International Monetary Fund. Inflation, consumer prices (annual %) - Iran, Islamic Rep. 2021, [cited 16 January 2023]. Available from: https://data.worldbank.org/indicator/FP.CPI.TOTL.ZG?locations=IR.

  • 7.

    Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9(9):CD009790. [PubMed ID: 34580864]. [PubMed Central ID: PMC8477273]. https://doi.org/10.1002/14651858.CD009790.pub2.

  • 8.

    Mu J, Furlan AD, Lam WY, Hsu MY, Ning Z, Lao L. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;12(12):CD013814. [PubMed ID: 33306198]. [PubMed Central ID: PMC8095030]. https://doi.org/10.1002/14651858.CD013814.

  • 9.

    Parry SP, Coenen P, Shrestha N, O'Sullivan PB, Maher CG, Straker LM. Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers. Cochrane Database Syst Rev. 2019;2019(11):CD012487. [PubMed ID: 31742666]. [PubMed Central ID: PMC6953379]. https://doi.org/10.1002/14651858.CD012487.pub2.

  • 10.

    Becker BA, Childress MA. Nonspecific Low Back Pain and Return To Work. Am Fam Physician. 2019;100(11):697-703. [PubMed ID: 31790184].