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Anil Burange has left no stone unturned to cure the chronic lower back pain that his 60-year-old mother Savita has been suffering for the last 15 years. Now living in Mumbai’s Andheri, he has consulted every specialist, hoping one of them could help her feel normal and in control again. “My mother has suffered nagging back pain for the last 15 years. Ice therapy, mobility exercises and pain relief medication help for a few months or so. But once their effect wears off, she is unable to carry out basic household chores,” says Anil.
Savita is currently being examined by a top spine specialist at Pune’s Sancheti hospital and says she feels weak with the pain radiating all the way to her legs. “I have met multiple doctors and taken pain block injections but to no avail,” she says, distressed. As she waits for her consultation, a 55-year-old secondary school teacher says how standing during her classes and lack of exercise had aggravated her low back pain. “I must have had at least two to three episodes of severe low back pain in a year. Things get so bad despite pills that I have to unfortunately remain absent from work,” she says. Savita has been diagnosed with a dehydrated chronic lumbar disease while the teacher has a severe lumbar disc bulging problem.
One of the top reasons for missing work, low back pain can start with a niggling ache to shooting pain, according to Dr Shailesh Hadgaonkar, chief spine surgeon at Sancheti Hospital. His daily patient load is approximately 70. This number corroborates a new report published in The Lancet Rheumatology that says there are more than half a billion prevalent cases of low back pain worldwide. It predicts 800 million cases by 2050.
HOW LOW BACK PAIN COMPROMISES AGEING
“Besides absenteeism from work, low back pain might force workers to retire prematurely. Prevalence and years lived with disability due to low back pain increase with age, peaking at 85 years, and compromise the prospect of healthy aging. Emphasis should be given to integrated and early return to work interventions,” say experts in the report. Surgery can be useful in selective cases, but it is not always the solution, feels Dr Hadgaonkar. “Chronic back pain is often related to increasing age and common causes include arthritis of the spine, spinal stenosis and disc problems like a bulging disc. That’s why a non-surgical pain management protocol is often advised in a majority of cases,” he adds.
MODIFIABLE RISK FACTORS FOR BACK PAIN
Low back pain forces more people out of the workplace than any other chronic health condition. Estimates show that three modifiable factors play an important role in the global burden of low back pain. Nearly one-quarter of those living with the condition attributed it to occupational ergonomic factors, including prolonged sitting or standing, bending or lifting. In 2020, globally and across all ages and genders, 22 per cent of cases were because of occupational ergonomic factors, 12.5 per cent cases were because of smoking and 11.5 per cent complaints were because of high BMI (body mass index). The risk of low back pain attributed to smoking was the highest among the middle-aged (50–69 years) whereas the risk attributed to occupational ergonomic factors was highest among younger patients (15–49 years). The risk of low back pain attributed to high BMI was, however, highest among women aged between 50 and 69.
LOW BACK PAIN IS HIGHER IN WOMEN THAN MEN
Bone degeneration with age, pregnancy, pelvic structural differences between men and women and hormone issues make women more prone to lower back pain. “In India, we need to invest in documenting the prevalence of low back pain, its risk factors and the means people adopt to manage the pain. All this can facilitate the formulation of prevention strategies at the population level, mitigation of low back pain in the workplace, along with the availability of appropriate rehabilitation services. The prevalence of low back pain is higher in women than in men, so gender-intentional strategies are needed so that women are benefitted. Also, it is important to include a focus on musculoskeletal conditions broadly in the Non-Communicable Diseases (NCD) programme,” says Dr Rakhi Dandona, Professor, at Public Health Foundation of India (PHFI). She also makes a strong case for investing in documenting the prevalence of low back pain, its risk factors and means people adopt to manage the pain.
87.5 MILLION CASES IN INDIA
Low back pain remains the leading cause of Years of Living with Disability (YLDs) globally, and in 2020, there were more than half a billion prevalent cases of low back pain worldwide. “The Lancet study has estimated 87.5 million cases of low back pain in India. This number is likely to be an undercount because of the lack of availability of data on musculoskeletal conditions. Also, these estimates have not taken into consideration the impact of COVID-19,” says Dr Dandona, who was also part of the study published in The Lancet.
