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The natural course of low back pain and early identification of high-risk populations

Lise Hestbaek  

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Accepted by: The Faculty of Health Sciences University of Southern Denmark
Defended on: June 19, 2003
Official opponents: Overlæge Fin Biering-Sørensen , Professor Anders Green , Overlæge Karsten Thomsen
Tutors: Forskningschef Charlotte Leboeuf-Yde, DC, MPH, PhD , Professor, overlæge, dr.med. Claus Manniche , Lektor Kirsten Ohm Kyvik, MD, PhD

Published in the PhD Database: October 11, 2005

English abstract
Introduction: The natural course of low back pain (LBP) is still largely unknown. Some authors theorize that acute LBP is merely a stage in a chronic condition, characterized by variation and change rather than a self-limiting course. The present project investigates this theory. If LBP does prove to be recurrent rather than self-limiting, it is of major importance to identify the problem early. There is now evidence that LBP originates early in life and that people with LBP in adolescence have a high risk of recurrences throughout life. Most research in the causality field of LBP has so far focused on risk factors rather than risk populations. Therefore, the second part of this project is aimed at identification of a ¿frail¿ subgroup of youngsters who are prone to develop LBP.
Materials and methods:
¿ A systematic and critical review of the literature relating to the natural history of LBP.
¿ Analysis of data from a five-year, prospective, population based survey of 1,370 30-50 year old individuals (The Ebeltoft Health Promotion Study) to investigate the course of LBP.
¿ A systematic and critical review of the literature relating to comorbidity with LBP.
¿ Analysis of data from a cross-sectional population based survey of 9,567 12-22 year old twins (The Danish Twin Registry and The Danish Medical Birth Registry). LBP-data were analyzed for associations with other diseases as well as birth characteristics and, finally, the heredity of LBP among adolescents was estimated.
¿ Results confirm that the course of LBP is characterized by exacerbations and remissions.
¿ All disorders investigated previously, with the exception of diabetes, showed positive associations with LBP in adults.
¿ There is an increased risk of LBP in adolescents suffering from asthma and headache. This risk increases significantly in subjects suffering from several disorders. Thus, disorders, including LBP, cluster in some individuals.
¿ There is a weak positive association between high birth weight and LBP in males
¿ There is a significant genetic component of the liability to develop LBP. The influence of this in relation to the non-shared environment decreases from age 12 to age 19.
Future implications:
Since LBP is associated with other disorders already in adolescence, these associations cannot be explained merely by external factors in adult life, but might have, at least partly, a common origin, indicating a general frailty. It is possible, that such an underlying frailty also predisposes for chronic/recurrent LBP in adulthood. A planned follow-up study will follow these adolescent into adulthood. If such a frail subgroup can be identified already in childhood or adolescence, selective preventive efforts, including career-counseling, are possible.

Danish abstract
Baggrund: Der er evidens for, at rygproblemer starter tidligt i livet, og folk med lændeproblemer i ungdommen har øget risiko for lænderygproblemer senere i livet. Den hidtidige etiologiske forskning på området har primært fokuseret på risiko-faktorer hos voksne fremfor risiko-grupper. Dette projekt forsøger først at klarlægge det spontane forløb af lændeproblemer, dernæst at karakterisere en