El dolor lumbar inespecífico en un grupo de hombres adultos jóvenes

8/3/2019 El dolor lumbar inespecfico en un grupo de hombres adultos jvenes

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Turkish Neurosurgery 2011, Vol: 21, No: 2, 135-139 135

ABSTRACTAIm: Low back pain (LBP) is a common symptom that causes enormous social, psychological, and economical problems. We studied LBPoccurrence in a group o young adults reerred to an army hospital or a planned health check and evaluated possible causative actors byprospective questionnaires.

mAterIAl a methOds: This article is based on a prospective study o 871 novice soldiers o the Turkish Army. Studied actors werecombined in the orm, which was illed by 5 doctors on the basis o sel-reports, interview and physical examination o the participants. Theywere evaluated by actors; low back pain episodes, monthly income, smoking habits, BMI, labor conditions, and educational status.

results: The median age o the studied population was 21.141.4. Complains regarding LBP were observed in 325 (37%) o participants.Twelve participants had pain episodes up to 10 points. 83.69% o the participants with LBP had psychological problems. Heavy liting anddriving or long periods were determined as serious risk actors.

COnClusIOn: Determining the impact actors o LBP in primary care groups can help to prevent development o more serious problems.

KeywOrds: Low back pain, Epidemiology, Young adult men

Z

AmA: Bel ars ciddi sosyal, psikolojik ve ekonomik problemlere yol aan yaygn bir semptomdur. Bu almada, dejenerati deiikliklerinnadir izlendii gen erikin dnemdeki askerlik grevini yapmak iin bavuran erkeklerin ilk muayeneleri srasnda prospekti olarak hazrlanananket ile bel ars epidemiyolojisi ve belirleyici nedenleri deerlendirilmitir.

yntem v Gere: Bu almada askerlik grevini yapmak iin bavuran yalar 20-32 arasnda arasnda deien 871 erkek almayaalnmtr. alma iin adaylara ya, boy, kilo, eitim durumu, ekonomik geliri, kullandklar sigara says, bel ars olup/olmad veya bel arsata geirip geirmedikleri, bel ars olanlarda arnn iddeti, daha nceden yardm almasn gerektiren psikolojik rahatszlk ve almakoullar parametrelerini ieren ormlar hazrland. Bu ormlar 5 doktor tarandan asker adaylar ile bire bir grlerek doldurulmutur.

BulGulAr:allan poplasyonun ya ortalamas 21,141,4/ yl. 325 (%37) kiide bel ars vard. 12 katlmcnn ar skoru 10 puana kyordu.Ciddi bel arl bu olgularda %83,69 psikolojik sorunlar gzlendi. Bunun yannda, ar yk kaldrma, ar sigara, uzun sre ara kullanlmasbelirleyici risk aktr olarak bulunmutur.

sOnu: Gen erikin grup bel arl olgularda; rol oynayan etkili aktrlerin erken belirlenmesi ciddi problemlerin nlenmesini salayabilir.

AnAhtAr sZCKler: Bel ars, Epidemiyoloji, Gen erikin erkek

Correspodece address:Mehmet SECER / E-mi: [email protected]

Mehmet SEcEr1, osm ai nacar2, M. Jhgi MuraDov3, Ftih alTInToprak4, Bis kaBalI4,zfe SEnol4, k. aishe uMarov3

1Sehitkamil State Hospital, Neurosurgery Clinic, Gaziantep, Turkey2M.H. Numune Educational and Training Hospital, 2nd Neurosurgery Clinic, Ankara, Turkey3Tashkent Medical Academy, 2nd Neurosurgery Clinic, Tashkent, Uzbekistan4Siirt Military Hospital, General Surgery Clinic, Siirt, Turkey

nospecific Low Back Pai i a Group of YougAdult Me

Gen Erikin Erkek Grubunda Bel Ars

Received: 12.07.2010 /Accepted: 05.01.2011

InTRoduCTIon

Low back pain (LBP) is an enormous social, psychological,and economic problem. It is estimated that 15% to 20% oadults may have an attack o back pain in a single year, and50% to 80% experience at least one episode o back painduring their lietime. Low back pain aects all ages, romadolescents to the elderly, and is a major cause o disability inthe adult working population. Risk actors or spine pain aremultidimensional: physical attributes, socioeconomic status

and the general medical health and psychological state, andoccupational environmental actors all contribute to thepossibility o experiencing this type o pain (19, 21).

In general, LBP is maniested at the beginning o an adultsactive social lie (2024 years), reaching its peak in those agedover 40. Early recognition o the causes o LBP is importantor the prevention o urther problems (2, 4). In this study, weinvestigated the occurrence o LBP in a group o young adultsadmitted to an army hospital or scheduled health checks and,


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Turkish Neurosurgery 2011, Vol: 21, No: 2, 135-139136

Secer M, et al:Nonspecific Low Back Pain

through the use o a prospective questionnaire, examined thepossible causative actors o LBP.

MATERAL a METHodS

This article is based on a prospective study o 871 novice

soldiers, aged 2032 years (median age 21.14 1.4 years), ata Turkish army base. The actors listed in Table I were includedin the orm, which was completed on the basis o sel-reports,interviews, and physical examinations o the patients.Episodes o LBP occurring over the past year, with durationo more than one week, were considered to be substantialand were assessed by a visual analogue scale (VAS). Theeducational status o the participants was coded accordingto the stages o the educational system in Turkey: elementaryschool, high school, and university. Monthly income wascoded as 0500 TL Group 1; 500999 TL Group 2; 1000 TLand more Group 3. The irst two groups were considered lowincome groups, while the third group was considered high

income. Smoking was categorized as: non-smokers; thosewho smoke less than 20 cigarettes per day; and those whosmoke more than 20 cigarettes per day. The body mass indexwas determined or each participant using the ollowingormula: BMI = weight/height. The working conditions o theparticipants were classiied as shown in Table II. The irst threecategories indicate low spinal stress and the last three groupsindicate heavy spinal stress.

Statistical analysis was perormed with the Statistica 6.0(StatSot Inc.) program. Medians were counted or continuousvariables and Fishers exact and correlation indexes were usedor matched pairs. The Kolmogorov-Smirnov test was used todetermine normal values or the variables.

RESuLTS

Low back pain was reported by 325 o the 871 (37%) studyparticipants. Among the study population, there was no

distinct dierence in LBP between age groups (p>0.05) orBMI (p>0.05). In the general population, the normal BMIvalue is 2025.9 kg/m. An increase o this index is acceptedas a risk actor or LBP. In our study, 50 responders had highBMI values; in those with BMI 0.05) (Table III).

Analysis o the VAS data indicates that 12 participantshad experienced pain episodes assessed at 10 points, 4participants 9 points, and 2 participants 8 points, all owhich are considered quite severe. In our study, 325 (83.69%)participants with LBP had experienced psychologicalproblems (p0.05) and monthly income (p>0.05) othe participants had no correlation with the occurrence opain, as there was no reliable dierence between the values in

the group o responders with LBP and the group without LBP.Regarding participants with smoking habits, we notedthat smoking up to 20 cigarettes per day did not result in areliable dierence; however, among heavy smokers, 23%o participants experienced LBP and 17% o the group oparticipants ree o LBP had a reliable dierence by Fishersexact test (p>0.05).

Table I: Studied Factors

name f factr Cig f factr

Age Years

Sex Male

Weight Kg

Height CmBMI Kg/m2

Labor status 6 groups: based on physical activity

Education 3 groups: elementary school, secondary school, and high school

Financial status 3 groups: based on monthly income or the last 3 months

Low back pain severity VAS 10 points coding

Smoking habits Average daily number o cigarettes smoked or the last 6 months

Psychological statusNo psychological problems, or experiencing psychological problems (has visitedpsychologist)

Table II: Coding o Work Activity

Group 1 Easy work

Group 2 Sitting or extended periods

Group 3 Standing and walking or extended periodsGroup 4 Heavy workload

Group 5a Driving or extended periods

Group 5b Track driving or extended periods


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The infuence o labor conditions on LBP did not show asigniicant dierence between the two groups as to theoccurrence o LBP (p>0.05) (Table IV).

dISCuSSIon

Leboeu-Yde and Kyvik investigated the development o LBPproblems in 29,424 Danish twins and ound that the patternor the one-year prevalence o LBP was very similar to thator lietime prevalence; both started at 7% (95% conidenceinterval, 59%) or 12-year-old individuals and reached 56%(95% conidence interval, 5359%) and 67% (95% conidenceinterval, 6271%), respectively, or 41-year-old individuals.The authors concluded that steps toward the prevention oLBP need to be ocused during childhood and adolescence(13).

Our results showed that yearly occurrence o LBP episodes ora population o 21.4-year-old men was 37%, which is quiteclose to the average rate ound in data in the literature.

A study on the impact o obesity on musculoskeletal systemdiseases by Tsuritani et al. showed that LBP (occasionally orrequently) was the most common symptom in 40.3% o thesubjects. The pain score or legs and diiculty o daily activityscore increased signiicantly with age. Higher BMI was relatedto increased prevalence o requent leg pain and diicultyscore (>3), but there were no signiicant associations betweenage or BMI and scores or back pain (20).

In our study, no individual had a BMI over 30 kg/m. Fityparticipants had BMIs between 25 and 30 kg/m; thisborderline data was not a reliable risk actor or LBP problems.We consider that this is related to the age o the studiedgroup, as obesity and resulting cardiovascular problemsbecome more signiicant actors ater the age o 40 (15).

Educational level rarely changes ater 2025 years o age.We could not ind any reliable dierence in LBP according toeducational status. The results o a study by Hestbaek et al.supported our data; they concluded that there are no or veryweak indications o possible relationships between socialactors in adolescence and LBP at baseline and at ollow-up(9).

Interestingly, Hagen et al. concluded on the basis o theirstudy that education level has a strong and unexplained eecton back pain disability pensioning, and is not mediated by

occupational class, working conditions, or individual liestyle(7). We note that this act may dier by country and evenamong various population groups (city versus village) andmay depend on manual labor in production or manuacturingacilities. People in low socioeconomic groups mostly workunder toxic, risky, non-hygienic conditions and oten claimhealth certiication beneits or alse long standing disease.

Regarding the infuence o smoking on LBP, variousinvestigators have postulated that: 1) coughing rom smokingincreases internal abdominal pressure and intradiscalpressure and thus strains the spine (14); 2) nicotine reduces

Table III: Fishers Test or Age and BMI Variables

Variable Experiecig LBP nt experiecig LBP p vale

Age 21.14 1.41 21.15 1.41 0.98

BMI 22.92 1.84 22.99 1.91 0.46

Table IV: Chi-square Test or the Infuence o Factors on LBP Occurrence

Factr ValesExperiecig LBP

=325nt experiecig LBP

=546Chi- sqare p vale

Psychological problemsYesNo

53 (6.08%)272 (31.22%)

26 (2.98%)520 (59.7%)

32.93 0.00*

High educationNoYes

307 (35.24%)18 (2.06%)

514 (59.01%)32 (3.67%)

0.04 0.84

Monthly incomeLowHigh

311 (35.95%)14 (1.61%)

513 (59.30%)27 (3.12%)

0.22 0.64

Smoking more than 20cigarettes/day

NoYes

250 (28.7%)75 (8.61%)

453 (52%)93 (10.67%)

4.78 0.028*

Heavy workloadNoYes

126 (14.46%)199 (22.84%)

196 (22.50%)350 (40.18%)

0.72 0.39

* - p


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Turkish Neurosurgery 2011, Vol: 21, No: 2, 135-139138


As stated by Leboeu-Yde, we should look or populationsat risk, rather than determining risk actors. Populations atrisk would consist o those with weak psychological andphysiological constitutions, who may readily develop chronicLBP (12).

We can conclude that certain actors (psychological, smoking,low educational status) o daily living lead predisposedpersons to the development o musculoskeletal problems.

ConCLuSonS

Determining the actors impacting LBP in young adults canhelp to prevent the uture development o more seriousproblems.

REFEREnCES

1. Deyo RA, Bass JE: Liestyle and low-back pain. The infuence osmoking and obesity. Spine (Phila Pa 1976) 14:501-506, 1989

2. Ebbehoj NE, Hansen FR, Harreby MS, Lassen CF: Low back pain in

children and adolescents. Prevalence, risk actors and prevention.Ugeskr Laeger 164:755-758, 2002

3. Erginoz E, Alikasioglu M, Ercan O, Uysal O, Ercan G, AlbayrakKaymak D, Ilter O: Perceived health status in a Turkish adolescentsample: Risk and protective actors. Eur J Pediatr 163:485-494,2004

4. Feldman DE, Shrier I, Rossignol M, Abenhaim L: Risk actors or thedevelopment o low back pain in adolescence. Am J Epidemiol154:30-36, 2001

5. Frymoyer JW, Pope MH, Clements JH, Wilder DG, MacPhersonB, Ashikaga T: Risk actors in low-back pain. An epidemiologicalsurvey. J Bone Joint Surg Am 65:213-218, 1983

6. Gilgil E, Kacar C, Butun B, Tuncer T, Urhan S, Yildirim C, Sunbuloglu

G, Arikan V, Tekeoglu I, Oksuz MC, Dundar U: Prevalence o lowback pain in a developing urban setting. Spine (Phila Pa 1976)30:1093-1098, 2005

7. Hagen KB, Tambs K, Bjerkedal T: What mediates the inverseassociation between education and occupational disability romback pain?--A prospective cohort study rom the Nord-Trondelaghealth study in Norway. Soc Sci Med 63:1267-1275, 2006

8. Hagg O, Fritzell P, Nordwall A: Characteristics o patients withchronic low back pain selected or surgery: A comparison withthe general population reported rom the Swedish lumbar spinestudy. Spine (Phila Pa 1976) 27:1223-1231, 2002

9. Hestbaek L, Korsholm L, Leboeu-Yde C, Kyvik KO: Doessocioeconomic status in adolescence predict low back pain in

adulthood? A repeated cross-sectional study o 4,771 Danishadolescents. Eur Spine J 17:1727-1734, 2008

10. Hellsing AL, Bryngelsson IL: Predictors o musculoskeletal pain inmen: A twenty-year ollow-up rom examination at enlistment.Spine (Phila Pa 1976) 25:3080-3086, 2000

11. Izci Y, Taskaynatan MA: Management o lower back pain in youngTurkish Recruits. Mil Med 169:824-828, 2004

12. Leboeu-Yde C: Back pain--individual and genetic actors. JElectromyogr Kinesiol 14:129-133, 2004

13. Leboeu-Yde C, Kyvik KO: At what age does low back pain becomea common problem? A study o 29,424 individuals aged 12-41years. Spine (Phila Pa 1976) 23:228-234, 1998

vertebral blood fow in the body, reducing disc nutritionand promoting disc degeneration (5); 3) smoking may beassociated with anxiety and depression, which exacerbates orprolongs back pain (1).

Our study revealed that the actual infuence o smoking

on LBP is dose-dependent. Seventy-ive (23.07%) o theparticipants had a habit o heavy smoking (more than 20 perday), which showed reliable interrelation to LBP occurrenceand severity.

Psychological problems are prominent actors in LBP andrelated issues. As shown in the results o Hagg et al.s study,patients with chronic LBP selected as candidates or surgerydiered signiicantly rom the control subjects ree o backpain by demonstrating more smoking behaviors, generalmorbidity, and depressive symptoms as well as heavieroccupational and sel-assessed workloads (8).

In our study, 272 out o 325 (83.69%) participants hadpsychological problems. There were positive and negativesigniicant eects between the two groups related to thisissue. Among the actors studied, we consider that the impacto psychological problems has the most infuence over theurther development o LBP signs and symptoms. Piko andNoemi demonstrated that atigue was the most requentpsychosomatic symptom in both sexes, ollowed by headacheand LBP, in a group o teenagers (17). A prospective cohortstudy by Power et al. provides evidence that psychologicaldistress more than doubles later risk o LBP (18).

Bearing heavy physical loads is one o the main causativeactors or the development o LBP. In their study, Hellsing andBryngelsson revealed that the prevalence o LBP increased

rom 38% to 74% during a 20-year period; the odds ratioor requent back/neck/shoulder problems at ollow-upevaluation was 2.2 (95% conidence interval, 1.57-3.24) ithe subject had been perorming heavy work (10). The jobcondition may be a consequence o low educational proile,psychological problems, and/or a smoking habit, so all actorsare interrelated.

In our study, we revealed that physical work (load carry,driving, truck driving) was not a reliable risk actor in thepopulation studied. We consider that age might make thedierence as changes in the spine related to occupation maydevelop ater the age o 40.

The results o a study by Erginoz et al. show that Turkish

adolescents (911th grade) are in a risk group or experiencingLBP problems as they perceive themselves as not very healthyand experience psychosomatic symptoms (3). More seriousback problems occur later in lie (at the age o 2645) asproven in the studies o Gilgil et al. (6) and Oksuz (16). Izci et al.evaluated 865 patients with LBP and analyzed the outcomeso surgical treatment versus medical treatment. They showedthat LBP is one o the major causes o lost work days in youngrecruits (11). Our study ocused on an age group betweenteenagers and adults and showed, under conditions othe existence o predisposition to LBP, which actors couldcontribute to the development o symptoms in the uture.


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18. Power C, Frank J, Hertzman C, Schierhout G, Li L: Predictors o lowback pain onset in a prospective British study. Am J Public Health91:1671-1678, 2001

19. Rubin DI: Epidemiology and risk actors or spine pain. NeurolClin 25:353-371, 2007

20. Tsuritani I, Honda R, Noborisaka Y, Ishida M, Ishizaki M, Yamada Y:Impact o obesity on musculoskeletal pain and diiculty o dailymovements in Japanese middle-aged women. Maturitas 42:23-30, 2002

21. Van den Hoogen HJ, Koes BW, van Eijk JT, Bouter LM, Deville W:On the course o low back pain in general practice: A one yearollow up study. Ann Rheum Dis 57:13-19, 1998

14. Nachemson A, Elstrom G: Intravital dynamic pressuremeasurements in lumbar discs. A study o common movements,maneuvers and exercises. Scand J Rehabil Med Suppl 1:1-40,1970

15. Naslindh-Ylispangar A, Sihvonen M, Sarna S, Kekki P: Healthstatus, symptoms and health counselling among middle-aged

men: Comparison o men at low and high risk. Scand J Caring Sci22:529-535, 2008

16. Oksuz E: Prevalence, risk actors, and preerence-based healthstates o low back pain in a Turkish population. Spine (Phila Pa1976) 31:968-972, 2006

17. Piko B, Noemi K: Psychosomatic symptom ormation as a healthstatus indicator in early adolescence: Behavioral epidemiologicanalysis. Orv Hetil 147:819-825, 2006

El dolor lumbar inespecífico en un grupo de hombres adultos jóvenes

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