1. THE EPIDEMIOLOGY OF BACK PAIN Environmental Health 5700UG

2. The Back Basics The epidemiology of back pain varies by occupational, ethnic, and gender groups.

3. > 75% of general population has suffered from low back pain at one time or another (approximately 5%- 10% will become chronic),

4. Point prevalence of low back pain is about 15%-20% in the general population

5. Back pain has a high recurrence rate, 20%-25% of cases recur within the first yearBack pain has a high recurrence rate, 20%-25% of cases recur within the first year

6. The point prevalence of The point prevalence of low back pain is about 15%-20% in the general population

7. Approximately 1% of all back injuries will require surgical intervention, e.g., disk herniation is most common condition

8. About 10% of back pain patients are out of work for more than 6 months, and these cases can be very expensive.

9. Direct and indirect medical costs are estimated as high as $100 billion annually

10. How to Measure the Epidemiology of Back Pain? Frequency Duration Intensity Effect on daily activities Cost

11. Increased Risk Factors? Previous history of back injury Younger age (« 30 years) Male gender Smoking Height (taller = greater risk)

12. More Risk Factors Anatomical defects {e.g., spinal curvature) Occupation {e.g., physical labor) Availability of insurance benefits {e.g., Workman's Compensation)

13. Risk Factors Associated with Chronicity of Back Pain Previous history of back pain Older age (> 30 years) Female gender Occupation (e.g., physical labor) Insurance benefits (e.g., Workman's Compensation) Initial diagnosis (e.g., "labelling" by physician)

14. Ergonomic Factors Associated with Back Pain Risk Posture (e.g., quality and duration) Level of physical effort (e.g., intensity, frequency, duration) Vibration level (e.g., partial or total body) Subjective perception of physical demand to perform a given task

15. Psychosocial Factors Associated with Back Pain Depression Job satisfaction Substance abuse Ethnicity

16. Assessment of Back Pain Diagnostics (e.g., x-rays, etc.) Symptoms Range of motion Strength Psychosocial measures (e.g., McGill and/or Quebec Pain Scales)

17. Intervention Most cases (after rule out of other problems) respond well to NSAIDs and as much normal activity as possible Saline injections found to be just as effective as corticosteroid injections Assess occupational and psychosocial factors for problem areas