Prevention of Low Back Pain: The Importance of Intervention from an Early Age

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Prevention of Low Back Pain: The Importance of Intervention from an Early Age要疼 从下就要干预的重要性
IntroductionChronic low back pain (LBP) is a global problem, impacting individuals and societies. The lifetimeprevalence of low back pain is reported to be as high as 84%, and the prevalence of chronic low backpain is about 23%, with 11-12% of the population being disabled by low back pain[1]. Risk factors for thedevelopment of chronic back pain include genetic predisposition, lifestyle and occupational factors, andaging [25].

Although the prevention of LBP offers improvements in quality of life and years lived with disability, bycontrast with evidence from a large number of trials that assess treatments for low back pain, evidencethat assesses prevention, particularly primary prevention, is inadequate, and is largely derived fromstudies of adults in high-income societies. Whether guidelines derived from available studies areapplicable to children, or implementable in low-income and middle-income countries, is not known[7].People with osteoporosis, degenerative spondylosis, and vertebral canal stenosis often experience LBP.Identifying the specific sources of the pain, however, can be difficult because of the interaction ofbiological and psychosocial factors [11, 23].

OsteoporosisOsteoporosis is defined by decreased bone density associated with an increased risk of fracture.Over 50% of women develop osteoporosis by their 70s and approximately 17% of men developosteoporosis by their 80s, with a lifetime risk of symptomatic vertebral fracture from age 60 of 18% forwomen and 11% for men [16, 24].

Osteoporosis can cause LBP, even in the absence of a defined fracture [17]. Osteoporotic fractures cancause acute pain, and result in spinal deformity (mainly kyphosis) and an increased risk of chronic pain.Although heritability accounts for 40-80% of the risk of developing osteoporosis, acquired factors, suchas nutrition status, exercise habits, and medical disorders are modifiable factors associated withosteoporosis [12, 18].

InterventionsEarly interventions are known to prevent the onset of osteoporosis. Ensuring the adequate dietaryintake of calcium and vitamin D, and participating in sports such as gymnastics, volleyball, basketball,and softball, are effective in maximizing bone mass in those under the age of 18 years, and decrease therisk of fracture in later life [5, 15, 21, 22]. Continuing these interventions into middle age is alsoimportant for preserving bone mass and reducing fracture risk [2]. Care must be taken in older age

groups, however, because unaccustomed exercise may cause adverse effects such as increased pain dueto muscle strains, joint injuries and fractures [13].Degenerative spondylosis may be associated with spinal malalignment (eg. kyphosis) and instability, alsoknown risk factors for developing LBP[4]. Correcting abnormal pelvic inclination, and improving spinalmuscle strength and neural control, are thought to be important in preventing or reducing LBP, withexercises that improve alignment and core muscle strength, such training the low back and abdominalwall muscles, are reported as effective [9]. A combination of strengthening with either stretching oraerobic exercises performed 2–3 times per week can reasonably be recommended for prevention of LBPin the general population [19].

Exercise is also effective in preventing occupational LBP, either alone, or in combination with activityspecific education programs. Ergonomic interventions, such as lumbar supports, lifting devices,workplace modification, job rotation, and modifications to production systems, appear less effectivethan exercise [8, 10, 20].

Educational interventions alone do not appear to be effective in preventing LBP, in children [14], adults[6], or in the workplace[10]. Mass media
campaigns designed to alter societal views about back pain andpromote behavior change have now been performed in several countries with mixed results[3].

ConclusionMore research is needed to develop and implement effective, including cost-effective, strategies thatprevent LBP and promote participation in physical and social activities.In summary, LBP is a global problem that requires innovative approaches to develop and implementpreventative strategies in order to reduce disability and improve quality of life. Improving nutrition andencouraging exercise currently appear to be the most effective strategies that can be implemented froman early age to prevent LBP.

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AUTHORSShuhei Nagai, MDMultidisciplinary Pain Center, Aichi Medical UniversityNagakute, Aichi, JapanTakahiro Ushida, MD, PhDMultidisciplinary Pain Center, Aichi Medical UniversityNagakute, Aichi, JapanOwen Williamson, FRCSC (Orthopedic Surgery & Pain Medicine)Chronic Pain Clinic, Fraser Health Authority, Surrey, British Columbia, Canada©Copyright 2020 International Association for the Study of Pain. All rights reserved.IASP brings together scientists, clinicians, healthcare providers, and policymakers tostimulate and support the study of pain and translate that knowledge into improvedpain relief worldwide.Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, AustraliaREVIEWERSBrona M. Fullen, PhDAssociate ProfessorUCD School of Public HealthPhysiotherapy and Sports ScienceDublin, IrelandProfessor Esther Pogatzki-Zahn, MD, PhDDepartment of Anesthesiology, Intensive Care and Pain MedicineUniversity Hospital MuensterMuenster, GermanySeiji Ohtori, Dr. med.Chiba UniversityChiba, Japan