I’ll bet you thought that at some point in life we might not be at risk of back or neck pain – guess what, we’re all wrong. This fascinating study by Jan Hartvigsen and Kaare Christensen looks at the prevalence and impact of back and neck pain amongst the oldest old – centenarians – in Denmark. What astounds me, apart from the thought that people would want to study this group, is that they had a 56% response rate and still obtained a sample of 256 people! The wonders of living in a place where everyone has a unique identifying number for all social benefits, medical care, or salary!!
So, what did they find… Well some of us would think that once we stop all that heavy work, we might find the prevalence of LBP and NP to reduce. After all, there are still many people ‘out there’ who believe that a major factor in the incidence of LBP is biomechanical demand. However, this study showed that over the past month, 27% of the respondents had experienced back pain, 22% had experienced neck pain, and 11% of the sample had both. A second study, reviewing Danish twins aged 70 years and over found a very similar result: 25% for back pain, 21% for neck pain, and 11% for both.
Among the 100-year olds, around 20% had been bothered by back pain either when moving (most common) or resting or sleeping. More than half of the centenarians rated their own health as excellent or very good. Poor overall physical function was associated with back or neck pain, higher depression score was strongly associated with back and also with neck pain, and rating ones health as less than very good was also associated with back and neck pain.
Diagnoses associated with low back or neck pain included: osteoarthritis, migraine headaches, current or previous diagnosis of disc prolapse, osteoporosis, and rheumatoid arthritis, hypertension, and heart disease were varyingly associated with back and neck pain.
The following quote, directly from the paper is, to me, the most important contribution of this study to our management of back pain:
the prevalence of these conditions at the very end of life is practically identical
to the prevalence in younger groups of seniors and similar to other ages from late childhood and youth over adulthood and into retirement. Furthermore, the many characteristics of back pain and neck pain seem to be quite similar between the ages, i.e., they are associated with poorer physical function, a number of comorbidities including depression and poorer self-rated health. It is therefore tempting to speculate that the occurrence of backand neck pain can regarded as fairly constant in the population, keeping in mind that the presence and intensity of symptoms tend to vary in individuals [my emphasis]
It’s a shame that the study didn’t go on to identify how many of the participants were actively seeking health care for their back pain, and that their measures don’t really ascertain severity. Ah well, you can’t get everything!
A further comment well worth reflecting on is: ‘…that there may be an underlying disposition to back pain and neck pain that is unrelated to age and age-related exposures resulting in a stable prevalence across age groups. Primary prevention may be an illusion since the pain is going to appear anyway and consequently we should focus on secondary prevention in order to avoid irrational pain behavior and chronicity, which is associated with over 80% of societal costs from back and neck pain.’
Given the observation that disability associated with back pain is the aspect that varies between populations in different countries, perhaps we could consider the negative influence on humans that medicalising a condition that, although painful and uncomfortable, is not fatal in itself.
Why do people have difficulty recovering from ALBP? On the whole it’s not the pain intensity – it’s the fear of experiencing pain that is disabling, as is the fear that pain equals damage. Where do these messages come from? Over the years, it’s come from medical and health care people and their messages that to have pain is bad, as well as a pervasive belief in Western civilisation that life should be happy and comfortable all the time.
And where is it written that life ‘should be’ happy and comfortable?
I’ll get back to you on that one, once I’ve found it!
Hartvigsen, J., Christensen, K. (2008). Pain in the Back and Neck Are With Us Until the End. Spine, 33(8), 909-913.