Increased Mortality Risk for Women With Back Pain

• A systematic review of 11 studies with 81,337 participants finds that women with back pain or any adult with severe back pain are at increased risk of mortality. 

• Speculated reasons include loss of motility leading to weight gain or cardiovascular disorders, and an increased risk of falls and fractures. 

• Age did not have an effect on mortality, and adults with mild back pain were not affected. 

This article was posted on Boston Medical Center News:

New research from Boston Medical Center identifies elevated mortality risk for women with back pain when compared to women without back pain. Back pain was not associated with mortality among men indicating long-term consequences of back pain may differ by sex. The overall findings suggest that mild back pain (pain that does not keep a person from exercising or doing daily activities) is unlikely to impact the length of one's life, but risk of mortality was increased among adults with more severe back pain. Published in the Journal of General Internal Medicine, this new study raises the question of whether better management of back-related pain and disability, over time, may extend life.

Back pain is the leading cause of disability worldwide, and disability and inactivity are generally associated with greater mortality. More than 80 percent of Americans experience back pain at some point in their lives, and older women are more likely to experience activity-limiting back pain.

Potential pathways between back pain and mortality were identified through the study including limitations in activities of daily living, and reduced physical activity that may lead to weight gain and the development or worsening of chronic conditions such as cardiovascular disease. Back pain has also been associated with poor balance and falls, which can result in fragility fractures. Such fractures are in turn associated with increased mortality.

Nonpharmacologic treatments recommended for treating back pain include acupuncture, chiropractic care, massage, and physical therapy. There is evidence that these treatments are effective for managing back pain and they are considered safe. Some treatments are known to have potentially serious side effects, such as opioids for pain management. Countless Americans have died as a result of the opioid epidemic, and low back pain is among the most common reasons why opioids are prescribed. The Centers for Diseases Control and Prevention released a report this week highlighting the continued impact of the epidemic with 87,000 Americans dying of overdose in the past year (ending September 2020), the highest number of overdose deaths ever recorded.

"I hope this study will lead to a better understanding of the long-term impacts of activity-limiting back pain on overall health and research to improve back pain treatment over the course of patients' lives," says Eric Roseen, DC, MSc, director of the Program for Integrative Medicine and Health Disparities at Boston Medical Center and an assistant professor of family medicine at Boston University School of Medicine. "Proper management of back pain is important, especially as the opioid epidemic has been exacerbated and the COVID-19 pandemic has impacted people seeking medical care, stress-levels and the environments in which many Americans are working right now."

This is the first systematic literature review on the association of back pain and mortality, and was followed by a meta-analysis of all-cause mortality in 11 studies with 81,337 middle-aged and older adults. Age did not appear to have an effect on the association between back pain and mortality in this review, an unexpected result considering past research showing the impact of back pain on disability increases with age. The highest risk of mortality associated with back pain was observed in studies that only included women, and those that identified adults with more severe back pain.

Future studies should focus on the complex relationship between back pain, back pain treatment, mental health, disability, and mortality.

This study was published in the Journal of General Internal Medicine in April 2021.