Back pain linked to increased mortality risk in women

Back pain was associated with a modest increase in all-cause mortality among women, according to findings from a systematic review and meta-analysis published in the Journal of General Internal Medicine.

“As a clinician taking care of patients with back pain, I had heard — and still often hear — other clinicians or researchers say, ‘back pain is disabling, but it doesn’t kill you,’” Eric J. Roseen, DC, MSc, an assistant professor of family medicine at Boston University School of Medicine, told Healio Primary Care. “I thought if back pain was the world’s leading cause of disability, and if disability was associated with mortality, then disabling or activity‐limiting back pain might be associated with mortality.”

To test his hypothesis, Roseen and colleagues reviewed 11 prospective cohort studies with 81,337 adults that evaluated the association between back pain with all-cause mortality. The mean age of the participants ranged from 40 to 83 years, and they were followed from 5 to 23 years. Five of the studies were conducted in Scandinavian countries, three had been performed in United Kingdom and one each was conducted in the United States, Israel and Australia.

The researchers reported that the presence of any back pain was not associated with an increase in mortality (OR = 1.06; 95% CI, 0.97-1.16), but it was associated with mortality in studies involving only women (OR = 1.22; 95% CI, 1.02-1.46) and adults with more severe back pain (OR = 1.26; 95% CI, 1.14-1.4).

“A consistent finding across studies is that mild back pain, or back pain that does not interfere with daily activity, does not appear to increase risk of mortality,” Roseen said in the interview. “However, more frequent or disabling back pain was associated with an increase in mortality. This is consistent with studies of other common musculoskeletal conditions.”

He noted that patients with back pain should continue with daily activities until they can no longer tolerate the pain. He also pointed out that the ACP recommends that patients with acute or chronic low back pain should try nonpharmacologic treatments first.

“Patients sometimes find that one of these approaches will work better for them, although more research is needed to match patients to particularly therapies,” Roseen said. “Back pain often reoccurs over time and these nonpharmacologic treatments can be safely used to manage back pain episodes or symptom flares.”

He cautioned that use of long-term pharmacological treatments — including NSAIDs and opioids, which have been linked to serious adverse events — “are typically only recommended for short‐term use.”