Back pain may raise risk of mental health problems

By Tim Newman

A study, involving almost 200,000 participants, finds that individuals who have back pain are more likely to also experience a range of mental health issues. Knowing about these links could form a more successful treatment plan for both sets of conditions.

Back pain is a leading cause of disability across the globe. In fact, it causes more global disability than any other condition.

According to the Global Burden of Disease study, lower back pain affects almost 1 in 10 people.

There is also a wealth of evidence that back pain negatively impacts quality of life and heightens the risk of other physical health problems. Additionally, it comes with substantial healthcare cost.

One earlier study of note used data from the World Mental Health Survey and found that chronic back or neck pain was associated with increased risk for mood disorders, alcohol abuse, and anxiety disorders.

Despite its high prevalence, little work has been done to investigate back pain's links with mental health outcomes in low- and middle-income countries (LMICs).

The largest back pain-mental health study to date

The latest and largest study to investigate the connections between back pain and psychological illness in LMICs was published this week in the journal General Hospital Psychiatry.

The research team - headed up by Prof. Patricia Schofield and Dr. Brendon Stubbs from Anglia Ruskin University in the United Kingdom - took data from 190,595 individuals aged 18 or older across 43 countries, making it the largest study of its type. Of the 43 countries, 19 were low-income and 24 were middle-income.

The team used data from the World Health Survey 2002-2004, a project set up by the World Health Organization (WHO) to "generate information on the health of adult populations and health systems."

Overall, in LMICs, back pain affected 35.1 percent of the population, and 6.9 percent reported chronic back pain. Of the countries investigated, China's levels of back pain were lowest, at 13.7 percent.

In some countries, more than half of respondents reported back pain; Nepal was highest with 57.1 percent. Similarly, 53.1 percent of Bangladeshis reported back pain, as well as 52 percent of people from Brazil.

Back pain and mental health

The analysis of the questionnaire data showed that, when compared with people without back pain, those who did experience back pain were more than twice as likely to experience one of five mental health conditions - anxiety, depression, psychosis, stress, and sleep deprivation.

People with chronic back pain were also three times more likely to experience a depressive episode and 2.6 times more likely to experience psychosis.

Interestingly, the results were relatively similar across all 43 LMICs, regardless of their standing on the socioeconomic ladder.

"Our data shows that both back pain and chronic back pain are associated with an increased likelihood of depression, psychosis, anxiety, stress, and sleep disturbances.

This suggests that back pain has important mental health implications which may make recovery from back pain more challenging. The exact reasons for this are yet to be established."

Dr. Stubbs

Because the study used such a large group of people across a section of populations, the findings can be considered highly reliable. As back pain is so prevalent in LMICs (and the world at large), any connection to mental health needs to be thoroughly understood. As Dr. Stubbs says:

"Further research is required to find out more about the links between these problems and to ensure effective treatments can be developed. It is also important that healthcare professionals are made aware of this link to refer patients to other services if necessary."