Priority Medicines for Europe and the World 2013 Update. Background Paper 6 - Priority Diseases and Reasons for Inclusion. BP 6.24 - Low Back Pain
(2013; 29 pages)

Abstract

Low back pain is a very common health problem amongst population and a major cause of disability that affects work performances and well-being. Low back pain can be acute, subacute or chronic. Though several risk factors have been identified such as occupational posture, depressive moods, obesity, body height or age, the causes of the onset of low back pain remain obscure and diagnosis difficult to make.

Low back pain affects children to elderly and is a very common reason for medical consultations. The Global Burden of Disease (GBD) 2010 estimated that low back pain is amongst the top ten DALYs (disability-adjusted life years) causing diseases and injuries.

Socioeconomic impacts are considerable in terms of work loss. Estimating the incidence of low back pain is difficult as the incidence of first-ever episodes of low back pain is already high by early adulthood and symptoms tend to recur over time. The lifetime prevalence of non-specific (common) low back pain is estimated at 60–70% in industrialized countries (one-year prevalence 15–45%, adult incidence 5% per year). The prevalence rate for children and adolescents approaches that seen in adults. It then increases and peaks between ages 35 and 55. As the world population ages, low back pain will increase substantially due to the deterioration of disc bones.

Low back pain (LBP) is the leading cause of activity limitation and work absence throughout much of the world, and it causes an enormous economic burden on individuals, families, communities, industry and governments. Several studies have been performed in Europe to evaluate the social economic impact of low back pain. In the United Kingdom, low back pain was identified as the most common cause of disability in young adults: with more than 100 million work days lost per year. In Sweden a survey suggested that low back pain increased the number of work days lost from seven million in 1980 to four times that (28 million) by 1987; however, authors state that social compensation systems might account for some of this increase. In the United States an estimated 149 million days of work per year are lost because of LBP. The condition is therefore costly, with total costs estimated to be between US$ 100 and US$ 200 billion annually, two-thirds of which are due to decreased wages and productivity.

At present low back pain is being treated with analgesics, alternatively rehabilitation can be prescribed. Causes of LBP are rarely being addressed. Disc surgery remains the last option when all other strategies have failed.

European Guidelines for the Management of Chronic non-specific Low Back Pain have been developed by experts in the field and provide guidance for diagnosis and treatment.
The European Commission is also funding the project "Genodisc" to identify risks factors, biomarkers and improve diagnosis of low back pain.

Research performed these past few years on biomaterial, growth factors or stem cells in the intra vertebral disc space brings new hopes for delaying the time before surgery.

Also, 3D imaging and using more resistant biomaterials for the development of more adapted disc prosthesis should help better addressing the issue of low back pain.

 
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