Sociodemographic profile of low back pain - Shaharnpur Spine

Original Article
Sociodemographic profile of low back pain - Shaharnpur Spine
Amarjit Sidhu*, Gursukhman Sidhu # , Ramesh C Jindal **, Banga Ajay***, Setia Nishat****
* Professor,** Assistant Professor, *** Senior Resident, **** Diploma Orthopaedics Student
Department of Orthopaedics
Maharishi Markandeshwar Institute of Medical Sciences and Research Mullana, Ambala
#
Research fellow
Jefferson Hospital, Philadelphia, USA
ABSTRACT
The general population and the medical community fully recognize that spinal conditions have an enormous
economic impact both on the world’s workforce and on its health care system. 1 Degenerative changes in the
spine is the another cause that may result in loss of spinal stability. 2 Spine is also vulnerable to conditions
like congenital anomalies, communicable diseases and trauma. This is a prospective non-controlled,
consecutive patient study investigating the Dorsolumbar part of the vertebral column of 100 adult patients
(68 males, 32 females) suffering from low back pain resulted from various diseases affecting the lumbar spine.
Objective of this study was to investigate the prevalence, the consequences and the risk factors associated
with low back pain among general population of district Saharanpur that included most of patients from
Mohhamadan community. Antero-posterior and lateral radiographs with MRI of lumbar spine were done in
all cases. Our series included 26 cases of Tuberculosis of spine, 23 cases of Osteoporosis, 21 cases of PIVD, 13
cases of lumbar canal stenosis, 8 cases of spondylolisthesis, 5 cases of spina bifida and 4 cases of compression
fracture.The onset of LBP in the present study is significant (P

Sidhu et al
part of spine that is subjected to heaviest mechanical stress. 7
History of onset is significant as it provides clues about the
nature of disease and identifies risk factors for developing low
back pain. Rural moderate workers are at significantly higher
risk of lumbar spine problems, it may be because people in rural
area are subjected to work with poor infrastructure that lead to
trauma to spine resulting in spinal degeneration and pain.
Tuberculosis is prevalent in developing countries with lumbar
and thoracic parts of the spinal column more frequently
affected. 8 To establish a diagnosis of spinal tuberculosis at an
early or late stage when deformities and neurological deficits
are present is the key factor that influences the outcome of the
treatment. Osteoporosis and lumbar spinal stenosis are the
most common musculoskeletal conditions in the elderly
population and also are one of the most common indications
for lumbar spinal surgery at an advanced age. 9 The direct and
indirect costs of Low Back Pain in terms of quality of life,
productivity and employee absenteeism are enormous making
this common condition the single largest contributor to
musculoskeletal disability worldwide. 10
MATERIAL AND METHODS
A structured questionnaire was administered to all the patients
to sought information on personal characteristics, sociodemographic
variables, job history, smoking status, presence
of any back pain in previous 12 months, severity of low back
pain, community, treatment of their condition and knowledge
about causes and prevention of low back pain.
Eligibility criteria: Inclusion criteria were patients with pain
in the low back and lower extremity with standing, walking or
spinal extension and neurogenic claudication.
1. The lower back pain was disabling to degree that the
patient could not perform his or her routine job without
restrictions and his or her lifestyle had been affected.
2. The exclusion criteria were chosen for safety concerns
as well as to eliminate known confounders that might influence
the results of the study or hinder participation and follow
through with study protocol. In addition we are excluding
patients with a history of lumbar fusion or decompression
surgery as well as interspinous process spacer procedures,
tumors etc.
Design of the study: This study is a prospective study on the
clinical course causes of low back pain in consecutive cases
presented to Outdoor. It concerns a one year of data collection
and the study did not interfere with the usual management of
low back pain by the general practitioner. The following
information was collected from the records: time between onset
of symptoms to first physiotherapy treatment, age, sex,
occupation, economic status, nature of back pain (acute/
subacute/chronic/recurrent), mechanism of injury, history of
smoking, radiology/ pathology, symptom location, time lost
from work due to LBP, history of LBP (previous mechanism of
injury, management etc).
Duration of the low back pain: At the initial visit patients
were asked to state the duration of the low back pain they were
suffering from. Recent onset and chronic low back pain were
defined according to the standards of Quebeck Task Force on
spinal Disorders. 11 Recent onset low back pain was defined as
having duration of less than seven weeks at the initial visit.
Chronic low back pain was defined as having duration of seven
weeks or more at the initial visit.
Clinical course of the low back pain: To ascertain the course
of the low back pain and the related disability after the initial
visit, the monthly questionnaires consisted of: a question
asking whether the patient had experienced low back pain in
each of the five foregoing weeks, a visual analogue scale at the
existing low back pain, and the Roland disability scale. 12
The time to recovery of the index episode: The time to
recovery, that is the duration of the index episode of low back
pain, was defined as the number of weeks from the initial visit
to the end of the episode. A four week pain free period was
chosen to define the end of an episode, as in most cases the
consecutive weeks with low back pain after the index visit were
followed by one or more weeks with low back pain, interspersed
by a number of weeks without low back pain. In our opinion, it
would not be right to ignore these periods. Consequently, the
episode was considered to have lasted until the first pain free
period of four weeks.
RESULTS
Demographic characteristics(Table 1): Out of 100 patients
68 were male and 32 were females. Most of the patients fell in
elderly age group with 47% between the ages of 41-50. As far
as profession is concerned most of the patients were associated
with wood carving (30%), textile industry (25%) and manual
laborer (22%) followed by housewives (15%) and shopkeepers
(8%). Among all the patients (68%) belong to low
socioeconomic, (28%) belong to middle and only 4% belong to
high socioeconomic status. Most of the patients were from
Mohhamadan (75%) community followed by Hindu community
(25%) and others (5%).
Perceptions and consequences of LBP (Table 2): More than
2/3 (84%) of the LBP sufferers developed LBP only after starting
work and (62%) claimed that the LBP was work related. Most
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Sociodemographic profile of low back pain
Sex
Table 1
Demography characteristics
Males 68
Age
Females 32
20-30 08
31-40 36
41-50 47
51-60 09
Socioeconomic status
Low 68
Middle 28
High 04
Profession
Wood carving 30
Textile industry 25
Manual laborer 22
Housewives 15
Shopkeepers 08
Religion
Mohhamadan 75
Hindu 20
Others 05
respondents described their LBP as localized (57%), whereas
(33%) complained of LBP associated with numbness or pain
radiating to the lower limb. The consequences of LBP on
personal life and work were moderate according to most LBP
sufferers (42%) while severe in (20%). Of LBP sufferers, (65%)
sought treatment for their symptom; of those who sought
treatment, 60% received traditional treatments, 27% modern
treatments and 13% both. Most were never diagnosed by a
health care professional and only 5% underwent surgical
procedures related to their LBP.
Table 2
Perceptions and Consequences of LBP
Develop LBP before or after working
Before working 16
After working 84
Related to work
Yes 62
No 38
Characteristic of LBP
Localized LBP 57
LBP with Numbness or pain in
Buttock/leg 33
Frequency of LBP
Daily 53
Weekly 36
Monthly 11
Recovery of LBP
12 weeks 09
Effect of LBP on personal life
Little effect 38
Moderate effect 42
Severe effect 20
Effect of LBP on work
Little effect 34
Moderate effect 45
Severe effect 21
Modified Job due to LBP
Yes 57
No 43
Treatment of LBP
Yes 65
No 35
Types of treatment
Modern 27
Traditional 60
Both 13
Receive any Spine Surgery
Yes 05
No 95
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Sidhu et al
Heavy Physical work 45
Poor posture 20
Prolonged sitting or standing 24
Falls 06
Do not know 05
Perceived causes of back pain are showed in Table 3.
Professional risk factors associated with low back pain
(Table 4): The workplace factors associated with LBP were the
seniority in the establishment, professional categories, work
posture, necessity of lifting objects, self-reported knowledge,
job satisfaction and job stress. Of these professional categories,
bad body posture, lifting objects, increased levels of lifting,
levels of job satisfaction and job stress revealed significant
correlation to LBP (P20 64
Bad body posture
Table 4
Professional risk factors
Yes 68
No 32
Knowledge
Not knowledgeable 28
Little Knowledge 54
Knowledgeable 18
Job Satisfaction
Poor 17
Neutral 63
High 20
Stressful
Agree 57
Neutral 35
Disagree 08
Job years
0-5 years 50
6-10years 20
11-15years 12
16-20years 06
>20years 12
The variability in LBP prevalence may be explained by the
methodological heterogeneity used for the assessment of LBP
as well as by differences in the gender, profession and age
group of the other study populations. The onset of LBP in the
present study is significant (P

Sociodemographic profile of low back pain
(30%) and manual laborer (22%). Tobacco consumption was
significantly associated with LBP (P