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Lower back pain to affect 843 million people in 2050, up 36% from 2020

Lower back pain, which is one of the main reasons for years lived with disability, will afflict 843 million people globally by 2050 and the root causes were smoking and being overweight, according to a study published in Lancet Rheumatology.

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May 24, 2023: Lower back pain, which is one of the main reasons for years lived with disability, will afflict 843 million people globally by 2050 and the root causes were smoking and being overweight, according to a study published in Lancet Rheumatology.

A global research team led by Prof Manuela Ferreira from the University of Sydney stated that a continued lack of a consistent approach to back pain treatment, and limited treatment options may lead to a healthcare crisis.

The team gleaned more than 30 years of data. The findings showed the number of cases of low back pain was growing, driven by population increases and ageing. In 2020, it was estimated that 619 million people reported having low back pain globally. Prevalence projections for low back pain suggest that in 2050, there will be 843 million individuals worldwide with low back pain, a 36.4% increase from 2020.

Implications of all the available evidence

The study analysed GBD data from 1990 to 2020 from over 204 countries and territories to map the landscape of back pain cases over time. 

The Global Burden of Disease is the most comprehensive picture of mortality and disability across countries, time, and age, and was also the first study to be used for modelling the future prevalence of back pain cases.

‘Enormous pressure’

“Our analysis paints a picture of growing low back pain cases globally, putting enormous pressure on our healthcare system. We need to establish a national, consistent approach to managing low back pain that is informed by research,” said lead author Prof Manuela Ferreira from Sydney Musculoskeletal Health.

“Currently, how we have been responding to back pain has been reactive. Australia is a global leader in back pain research; we can be proactive and lead by example on back pain prevention”, said Professor Ferreira who is based at Sydney’s Kolling Institute.

In Australia, there will be about 50% increase in cases by 2050. The landscape of back pain cases is set to shift, with the biggest increases in back pain cases to be in Asia and Africa.

Since 2017, the number of low back pain cases has ticked over to more than half a billion people. In 2020, there were approximately 619 million cases of back pain.

At least one-third of the disability burden associated with back pain was attributable to occupational factors, smoking, and being overweight. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more.

A widespread misconception was that low back pain, mostly affected adults of working age. But researchers said this study has confirmed that low back pain is more common among older people. Low back pain cases were also higher among females compared to males.

Musculoskeletal data

This is the most comprehensive and up-to-date available data that includes for the first time global projections and the contribution of the Global Burden of Disease risk factors to low back pain. 

“We also know that most available data come from high-income countries, making it sometimes hard to interpret these results for low to mid-income countries. We urgently need more population-based back pain and musculoskeletal data from countries of low to mid-income,” said senior author, Professor Lyn March from Sydney Musculoskeletal Health.

Dr Alarcos Cieza, Unit Head, World Health Organization, Headquarters, Geneva said: “Ministries of health cannot continue ignoring the high prevalence of musculoskeletal conditions including low back pain. These conditions have important social and economic consequences, especially considering the cost of care. Now is the time to learn about effective strategies to address the high burden and to act”.

In 2018, experts, independent of this study, had voiced their concerns in The Lancet and gave recommendations, especially regarding exercise and education, about the need for a change in global policy on the best way to prevent and manage low back pain to stop the rise of inappropriate treatments.

However, since then, there has been little change. Common treatments recommended for low back pain have been found to have unknown effectiveness or to be ineffective – this includes some surgeries and opioids.

No rules for older people

Professor Ferreira says there is a lack of consistency in how health professionals manage back pain cases and how the healthcare system needs to adapt.

“It may come as a surprise to some that current clinical guidelines for back pain treatment and management do not provide specific recommendations for older people.”

“Older people have more complex medical histories and are more likely to be prescribed strong medication, including opioids for back pain management, compared to younger adults. 

“But this is not ideal and can have a negative impact on their function and quality of life, especially as these analgesics may interfere with their other existing medications. This is just one example of why we need to update clinical guidelines to support our health professionals.”

Co-author Dr Katie de Luca, from CQUniversity, said if the right action was not taken, low back pain can become a precursor to chronic health conditions such as diabetes, cardiovascular disease and mental health conditions, invasive medical procedures, and significant disability.

“Low back pain continues to be the greatest cause of disability burden worldwide. There are substantial socio-economic consequences of this condition, and the physical and personal impact directly threatens healthy ageing.”

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