Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors
Written by Editor   
Friday, October 07, 2016 12:00 AM

Low back pain is a common health problem in the workplace, and most workers are expected to experience symptoms of low back pain during their working life.  Total costs of direct medical expenditures and loss of work productivity combined related to pain, including low back pain, have been estimated to be as high as $635 billion annually in the United States. 

This population-based study reported that the prevalence of self-reported low back pain in the previous three months among workers in the United States was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. Work-family imbalance, exposure to a hostile work environment, and job insecurity were associated with low back pain after adjusting for different demographic, socioeconomic, and occupational factors. Among all male workers’ occupations, health care practitioners had the highest risk for low back pain, whereas among female workers, farming, fishing, and forestry occupations had the highest risk. Long work hours (41-45 hours) were associated with an increased risk of low back pain. In particular, younger workers working for ≥60 hours and female workers working for 41 to 45 hours were associated with increased reporting of low back pain.

Considerable research conducted on this topic in the past three decades has identified a number of demographic, behavioral, and health- and work-related factors associated with low back pain.  The two major categories of work-related risk factors for low back pain are physical and psychosocial.

In the past, much of the research on work-related psychosocial risk factors was conducted within the job strain framework. Job strain occurs when there is a combination of high job demands and low job control. Job demands are operationalized as psychosocial demands (work pace, time pressure, competing demands), and job control is defined as job autonomy and skill discretion. This area of research has reported an association between job strain and low back pain, as well as the association between job demands and low back pain.

The purposes of this study are (1) to estimate low back pain prevalence in the general working population in different demographic groups in the United States; (2) to explore the associations between low back pain and a set of emerging workplace psychosocial risk factors in different demographic groups in the United States; and (3) to explore the associations between low back pain and a set of work organization− and job-related risk factors in different demographic groups of the working population in the United States.

This study reported that the general prevalence rate of low back pain among US workers in 2010 was 25.7%. This finding is consistent with other studies using the US working population data, which indicate a comparable prevalence rate of 28.0% in 2002 and 2006 and 25.3% in 2010. It also revealed demographic differences in low back pain prevalence: 23.8% for younger workers (18-40 years), 27.7% for older workers (41-64 years), 24.5% for male workers, and 27.1% for female workers. The finding is consistent with other studies that have reported similar age and sex differences.

Further, it reported an occupational pattern of low back pain by sex and age. Male health care practitioners had an increased risk for low back pain. Female workers in the farming, fishing, and forestry and health care support occupations had an increased likelihood of experiencing low back pain. In addition, younger workers in the health care support occupation had an increased risk for low back pain. These gender and age effects reported in this study are in line with the effects reported in several previous studies, especially in health care workers.

Long work hours in female (41-45 work hours) and younger workers (≥60 work hours) were associated with low back pain in this study. This finding appears to be in agreement with those from the population-based longitudinal analysis of workers in the United States by Dembe et al. In that study, a link was reported between overtime and long work hours to all forms of occupational injuries and illnesses, with 34.9% of these injuries and illnesses being musculoskeletal conditions.

Associations between several emerging psychosocial factors and low back pain were reported in this study. Workers who were exposed to a hostile work environment, work-family imbalance, or job insecurity were more likely to report low back pain. The risk associations were similar among different demographic groups, men and women, and younger and older workers. The associations between low back pain and these emerging psychosocial factors are consistent with evidence from a number of studies.

Work organization structures and job characteristics have changed profoundly during the process of globalization. Intensifying global economic competitions, increasing use of information technologies, continuing expansion of the service sectors, increasing female participation in the labor force, deregulations, increasing political and cultural openness, and fluctuating economy growth have been seen as features of globalization that are reshaping the ways people work and have heightened the complexities of the workplace psychological risk factors.

Under these circumstances, uncertainties about job security and flexibilities in work arrangements become the hallmark of jobs.  An increasing body of research has indicated deleterious health effects of job insecurity, including hypertension, poor sleep, depression, anxiety, and work-related musculoskeletal disorders such as back pain. This is probably due to possible economic deprivation that may occur after a lost job and concerns about future well-being.  A growing body of research indicates that job insecurity may lead to a threat to the health of workers comparable to or worse than that of unemployment. Mental strain associated with job insecurity may indirectly lead to “physiological vulnerability,” which, in turn, may contribute to low back pain.

Increasing numbers of women are entering the work force with increasing work intensity in the context of globalized economy. At the same time there has been a change in social norms that emphasizes equal importance of women and men both at work and in the family responsibilities. These changing roles for family members have heightened the importance of work-family imbalance as a health risk factor.  Work-family imbalance is considered to be a factor that is significantly and strongly associated with unhealthy behaviors as well as negative health outcomes.  There has also been new research linking exposure of work-family conflicts to low back pain.

One possible result of how work-family life imbalance is related to low back pain may be the draining of psychological and physical resources leading to unhealthy behaviors, including alcohol and tobacco use and decreased leisure-time physical activity. Another postulated pathway between work-family life imbalance and low back pain is that mental strain can cause muscle tension or other physiological processes that might aggravate low back pain.

An increase in psychosocial strain has been hypothesized to affect both biomechanical and physiological processes and one’s perception of pain. One of the implications of the findings in the present study is a need to develop public health and occupational health strategies, programs, and guidelines to reduce, manage, and prevent low back pain among different worker groups. This need is particularly urgent as the labor force will continue to age in the next decade. The total labor force is projected to increase 6.8% during the period of 2010-2020 in the United States, and the number of workers aged 55 and older will increase 25.8% during the same period.

In short, the findings of this study shed light on the field of research linking risk factors to low back pain and also provide support for intervention programs aimed at reducing and preventing low back pain in the workplace. Understanding these emerging work-related risk factors for low back pain is important if the resultant suffering, activity limitations, and loss of productivity for individuals and the social and economic impact of this condition at the societal level are to be addressed. These risk factors should be kept in mind by health care practitioners (eg, nurses, psychologists, physicians, physical therapists, and chiropractors) by employers who might wish to develop future multifactorial interventions at the workplace

Source:  http://www.jmptonline.org/article/S0161-4754(16)30134-8/fulltext?elsca1=etoc&elsca2=email&elsca3=0161-4754_201609_39_7_&elsca4=Physical%20Medicine%20and%20Rehabilitation%7CHealth%20Professions