As of 2015, lower back and neck pain were the leading global causes of disability[1]. Studies have consistently shown that there is an inverse relationship between socioeconomic status and prevalence of lower back pain. A study conducted in Finland comparing the trends for incidence of back pain in different population subgroups found that back pain was more common for people with lower education and income, for those working in blue-collar jobs, and those with high physical workload[2]. Another study conducted in Japan examined the relationship between socioeconomic status and lower back pain for older people. It also found that older individuals with a lower income level were more likely to suffer from lower back pain[3]. Similarly, a study conducted in China found that education level was negatively associated with back pain, and that low socioeconomic status is associated with a high rate of body pain [8]. The farmers surveyed in this study had a higher risk of chronic body pain and higher pain threshold compared to people with other occupations[8]. These studies demonstrate the importance of understanding and addressing this global phenomenon of higher incidence of lower back pain in people of lower socioeconomic status.

There are many reasons for this inverse relationship between wealth and lower back pain. Low socioeconomic status is associated with risk factors of lower back pain, such as depression, obesity, and smoking[3]. Causes for lower back pain are not purely biological but instead are biopsychosocial[4]. Biological risk factors (genes associated with back-pain-related phenotypes) interact with psychological and social risk factors like distress, depression, and societal beliefs around and expressions of pain[4]. Consequently, when holistically treating lower back pain, it is important to adopt a biopsychosocial model attune to psychological and biological concerns most common in lower socioeconomic classes.

The aforementioned inverse relationship holds true for adolescents as well. A study conducted in the South of Tunisia to understand the risk factors and consequences of neck, shoulder and low-back pain among school-aged adolescents found that they were more likely to suffer from lower back pain and shoulder pain if they lived with low or middle-income families[6]. Another Danish study investigating whether socioeconomic status in adolescence predicted lower back pain in adulthood found weak associations between them[7]. However, further studies need to be done to thoroughly investigate this association between lower back pain and socioeconomic status in children.

Complicating research on the relationship between lower back pain and socioeconomic status is the fact that classism can be prevalent in pain assessment for patients, as one study found by investigating how nurses’ pain assessment was affected by the patient’s socioeconomic status[5]. This study found that the pain of patients with lower socioeconomic status was perceived as less credible and less intense than that of patients with higher socioeconomic status, and the effect was consistent across age and gender[5]. It is imperative that healthcare professionals check their biases when assessing pain and use standardized pain measurement metrics that help reduce bias. 

Esurgi’s Biostabilizer can help physical therapists accurately assess pain for all patients, regardless of their socioeconomic status. The Biostabilizer is the only digital and automated Pressure Biofeedback Unit. It provides real-time pressure readings that help patients and physicians know with more objectivity whether proper core engagement is occurring during rehabilitation exercises. Do you think Esurgi’s Biostabilizer could help you better treat lower back pain?

Sources:

[1] Collaborators, G. 2. (2016, October 8). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Retrieved from NCBI PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055577/

[2] Heistaro, S., Vartiainen, E., Heliövaara, M., & Puska, P. (1998, October 1). Trends of back pain in eastern Finland, 1972-1992, in relation to socioeconomic status and behavioral risk factors. Retrieved from NIH: https://pubmed.ncbi.nlm.nih.gov/9778174/

[3] Ikeda, T., Sugiyama, K., Aida, J., Tsuboya, T., Watabiki, N., Kondo, K., & Osaka, K. (2019, January 21). Socioeconomic inequalities in low back pain among older people: the JAGES cross-sectional study. Retrieved from NCBI PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341699/

[4] Tânia Brandão, P. L. (2019, July 30). Classism in Pain Care: The Role of Patient Socioeconomic Status on Nurses’ Pain Assessment and Management Practices . Retrieved from Oxford Academic: https://academic.oup.com/painmedicine/article-abstract/20/11/2094/5540715?redirectedFrom=fulltext

[5] Johan W. S. Vlaeyen, C. G. (2018, December 13). Low back pain. Retrieved from Nature reviews: https://www.nature.com/articles/s41572-018-0052-1

[6] Houda Ben Ayed, S. Y. (2019, March 26). Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children . Retrieved from NCBI PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941626/

[7] Lise Hestbaek, L. K.-Y. (2008, October 2). Does socioeconomic status in adolescence predict low back pain in adulthood? A repeated cross-sectional study of 4,771 Danish adolescents . Retrieved from NCBI PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2587673/

[8] Tong Yu, L. Z. (2020, March 20). The association between the socioeconomic status and body pain . Retrieved from NCBI PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220486/

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