Debbie Feldman1 and Richard Nahin2, 1University of Montreal, Montréal, QC, Canada, 2NIH, Bethesda, MD
Background/Purpose: With the high prevalence of back pain and the high costs associated with the cases that become chronic there has been an emphasis on preventing chronicity. These costs may include those related to work disability, assistance for activities of daily living, long-term treatment, and management for chronic pain. We sought to evaluate the association between chronic severe back pain with disability and participation and explore associated factors in U.S. Adults using data from the US 2019 National Health Interview Survey.
Methods: The 2019 NHIS collected information on the persistence and severity of self-reported pain in the previous 3 months in 31,997 individuals. Dependent variables of pain-related disability and participation were: mobility disability, self-care disability, work participation and social participation. We determined prevalence of the four disability outcomes and constructed multivariable logistic regression models to assess the relationship between the four outcomes and various factors. These factors were comorbidities (including arthritis), sociodemographic factors (age, gender, socioeconomic status, race/ethnicity, education, work status, health insurance coverage), and personal health and related factors (body-mass-index, smoking status, perceived effectiveness of treatments).
Results: In our sample of 2,925 adults (weighted n: 20,468,134) who reported having chronic severe back pain, 60% reported mobility disability, 60% had work limitations, 34% were limited for social participation and 16% had self-care limitations. Older age (45-64) was associated with mobility difficulties (OR 2.02, 95% CI 1.40,2.92) and work limitation (OR 2.02, 95% CI 1.56,2.62). Lower socioeconomic status was associated with increasing odds of disability across the four categories. Being overweight was only associated with mobility difficulties (OR 1.43, 95% CI 1.02,2.01), while not working in the past week was associated with difficulties in mobility (OR 3.55, 95% CI 2.64,4.77), self-care (OR 3.39, 95% CI 2.18,5.05), and social participation (OR 3.14, 95% CI 2.10,4.71). Comorbidities were highly associated with limitations in all four categories. Those reporting arthritis were more likely to have mobility disability (OR 1.70, 95% CI 1.29,2.25) social participation limitations (OR 1.45, 95% CI 1.03,2.03) and work disability (OR 1.98, 95% CI 1.56,2.51). Those deeming their pain treatment ineffective were twice as likely to have limitations in self-care, social and work participation but not mobility.
Conclusion: Amongst those with chronic severe back pain, there is a substantial proportion with disability and reduced social and/or work participation. Identifying factors associated with increased likelihood of disability and limitation may help target appropriate management regimens for persons at high risk for disability.
