BACK PAIN 2018-04-06T23:17:19+00:00


Risk factors Age

• Normal ageing process causes increases progression

• 27% of those aged 63-70 had radiographic evidence of knee OA, increasing to 44% in over 80 age group Trauma

• Collateral ligament, meniscal tears and joint fractures lead to increased risk for OA

• Men with a history of known injury were at 5-6 fold increased risk of developing OA Occupation

• More common in those performing heavy physical work

• Dockers, miners and farmers found to have OA Exercise

• High impact sports present an increase for OA Gender and ethnicity

• Men under the age of 50 have a higher prevalence and incidence

• Women over 50 have a higher prevalence and incidence (menopause may be a trigger. However there is conflicting evidence if hormone replacement therapy protects against OA)

• Difference is less marked after the age of 80

• Generally more common in Europeans than in Asians Genetics

• There is genetic susceptibility to the disease • Children of parents with early onset OA are at a higher risk of developing OA themselves Obesity

• Strongest modifiable risk factor • Being overweight at an average age of 36-37 is a risk factor for developing knee OA Diet

• Threefold increase risk of progression of OA for people in the lower decile of vitamin C and D blood levels Bone density

• Increasing bone density may lead to increased loading through weight bearing joint cartilage

Back pain is a major health and socioeconomic problem in western countries. It usually is defined as pain localized below the line of the twelfth rib and above the inferior gluteal folds, with or without leg pain; and it can be classified as “specific” (suspected pathological cause) or “non-specific” (about 90% of cases). Back pain is usually defined as acute if it lasts less than six weeks; subacute if between six weeks and three months; and chronic when it lasts more than three months. Frequent episodes are described as recurrent back pain. Most episodes of low back pain settle after a couple of weeks, but many have a recurrent course, with further acute episodes affecting 20–44% of patients within one year in the working population and lifetime recurrences of up to 85%. Frequently, back pain never fully resolves, and patients experience exacerbations of chronic low back pain. Back pain is the second most common cause of disability in adults from the USA and a common reason for lost work days. An estimated 149 million days of work per year are lost because of back pain. The condition is costly, with total costs estimated to be between $100 and $200 billion annually, two-thirds of which are due to decreased wages and productivity. Incidence and prevalence Back pain is very common, but its prevalence varies according to the definitions used and the population studied. New episodes are twice as common in people with a history of back pain. Lifetime prevalence is 58–84% and the point prevalence (proportion of population studied that are suffering back pain at a particular point of time) is 4–33%.

• The current (2004) economic burden of arthritis in its various forms is approximately $82.4 billion.

• Direct costs are $34.6 billion (hospitals, doctors, transportation, nursing homes)

• Only 3% of the cost is for drugs.

• Indirect costs are $47.8 billion (primarily lost wages and lost productivity). Patients with OA suffer from pain and loss of function. Objectives of OA management are to reduce the level of pain, reduce inflammation, slow cartilage degradation, improve function and reduce disability. Non-pharmacological treatment

• Education (patient and spouse or family)

• Social support • Physiotherapy (physical therapy)

• Occupational therapy

• Weight loss

• Exercise-Exercise is considered the most important intervention in the management of OA. Exercise builds muscle strength and endurance, improves joint flexibility and motion.

• Orthotic devises

• Laser

• Pulsed EMF (Electromagnetic field therapy)

• Ultrasound

• Transcutaneous electrical nerve stimulation (TENS)

• Acupuncture

• Nutrients

• Herbal remedies

• Vitamins/minerals Pharmacological therapy review At present, there is no cure for OA. Pharmacological management of OA remains control of pain and improvement in function and quality of life while limiting drug toxicity. Surgical treatment Surgical treatment of osteoarthritis is usually considered after failure of nonsurgical therapies. There are four surgical procedures: osteotomy, arthroscopy, arthrodesis and arthroplasty. The four procedures have different indications and variable benefits. Total joint arthroplasty, the most surgically advanced in OA treatment, is the mainstay of surgical treatments.


Currently, the main treatment goal for low back pain is to control the pain, maintain function and prevent exacerbation. Pharmacologic treatment of back pain usually includes analgesics. Management of back pain can also involve musculoskeletal rearrangement through manipulations by various health care providers. These include physiotherapists, manual therapists, chiropractors, exercise therapists. Massage, ultrasounds, heat/cold, electrotherapy, laser and traction can substantially improve in certain cases the treatment of back pain. Surgical treatments are generally last resort option after all non-invasive treatments have been exhausted. Mechanical prostheses, which are currently implanted, have medium outcome success and have relatively high re-operation rates. Intradiscal injections of steroids or glucocorticoids have been used to treat discogenic pain or reduce inflammation in the disc.

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