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Low Back Pain and Sciatica Prevalence and Intensity Reported in a Mediterranean Country: Ordinal Logistic Regression Analysis

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Low Back Pain and Sciatica Prevalence and Intensity Reported in a Mediterranean Country: Ordinal Logistic Regression Analysis n Feature Article Low Back Pain and Sciatica Prevalence and Intensity Reported in a Mediterranean Country: Ordinal Logistic Regression Analysis PANAGIOTIS KOROVESSIS, MD, PHD; THOMAS REPANTIS, MD, PHD; SPYROS ZACHARATOS, MD, PHD; ANDREAS BAIKOUSIS, MD, PHD abstract Full article available online at Healio.com/Orthopedics. Search: 20121120-24 The objective of this retrospective cross-sectional study was to estimate the 6-month prevalence and severity of low back pain and sciatica in a representative sample of an adult Mediterranean population. The study group comprised a sample of 674 adults aged 20 years or older from a mainly (74.8%) urban population. Information regarding low back pain and sciatica prevalence and severity and its related aspects, as well as socioeconomic and demographic characteristics, was collected by per- sonal interviews with a validated questionnaire. The association between the inten- sity of low back pain and sciatica with several sociodemographic parameters was tested using ordered univariate and multivariate logistic regression analysis. A total of 266 (39.5%) patients reported low back pain and 166 (24.6%) reported sciatica during the previous 6-month period. A woman living in a Mediterranean country reported low back pain of increased severity if she was a married housewife aged older than 65 years who was a smoker and suffered from depression. More se- vere sciatic pain was reported by working married women older than 65 years who were smokers. Drs Korovessis, Repantis, and Zacharatos are from the Orthopedic Department, General Hospital “Agios Andreas,” Patras, and Dr Baikousis is from the Orthopedic Department, General Hospital of Messolonghi, Messolonghi, Greece. Drs Korovessis, Repantis, Zacharatos, and Baikousis have no relevant financial relationships to disclose. The authors thank Ms M. Andriopoulou and Mr B. Papanikolaou for their assistance in preparing this article. Correspondence should be addressed to: Panagiotis Korovessis, MD, PhD, Orthopedic Department, General Hospital “Agios Andreas,” 1 Tsertidou St, 26224 Patras, Greece ([email protected]). doi: 10.3928/01477447-20121120-24 DECEMBER 2012 | Volume 35 • Number 12 e1775 n Feature Article he lifetime prevalence of low back pain is reported to be more than Table 1 T70% in industrialized countries Anthropometric and General Data Affecting LBP and Sciatica (N5674) (1-year prevalence, 15% to 45%; adult incidence, 5% per year) with varying de- Parameter No. (%) Parameter No. (%) 1 grees of symptom severity. The preva- Demographic Socioeconomic lence of low back pain during school age Sex Residence approaches that seen in adults,2,3 increases Female 420 (62.3) Rural 170 (25.2) from childhood to adolescence,4 and peaks Male 254 (37.7) Urban 504 (74.8) between ages 35 and 55 years.5 Few studies specifically examine sci- Age, y Marital status atica, but some low back pain studies in- 20-45 408 (60.5) Unmarried 251 (37.2) clude data on sciatica prevalence, risk fac- 46-65 209 (31.0) Married 381 (56.5) tors, and natural history. Low back-related .65 57 (8.5) Divorced/widowed 42 (6.3) leg pain, or sciatica, is one of the most Nationality Education 6 common variations of low back pain. Greek 665 (98.7) Primary school 112 (16.6) Sciatica is known by a range of terms in Other 9 (1.3) Junior high school 46 (6.8) the literature, such as lumbosacral radicu- Employment High school 289 (42.9) lar syndrome, radiculopathy, nerve root Work status College 67 (9.9) pain, and nerve root entrapment or irrita- Employee 286 (42.4) University 160 (23.7) tion. Controversy exists in clinical and re- search circles about the use of sciatica as Self-employed 71 (10.5) Annual income, € a term.5,6 Although definitions of sciatica Housewife 61 (9.1) ,7000 201 (29.8) used in epidemiological surveys vary, sci- Agricultural worker 28 (4.2) 7000-14,000 209 (31.0) atic pain is generally defined as pain radi- Retired 45 (6.7) .14,000 264 (39.2) ating to the leg, normally below the knee Student 162 (24.0) Health related and into the foot and toes. As with low Multiple jobs 21 (3.1) Smoking back pain, sciatica is a symptom rather Work type No 444 (65.9) than a specific diagnosis, but lumbar disk Not manual 371 (55.0) Yes 230 (34.1) herniation and lumbar canal or foraminal Manual 158 (23.5) Antidepressive medication stenosis are typical pathologies that may cause sciatic pain. Combination 145 (21.5) No 648 (96.1) Patients with sciatica usually have a Yes 26 (3.9) more persistent and severe type of pain Abbreviation: LBP, low back pain. than patients with low back pain, have a less favorable outcome, consume more health resources, and have more prolonged It is well known among researchers (ie, second-level administrative division) disability and absence from work.5,7-12 that significant cultural, social, economic, located in the southwestern region of a Low back pain was long considered a and mentality differences exist between Mediterranean country with a mainly ur- mainly mechanical problem. However, in the people living in northern and southern ban population of approximately 350,000 the past decade, several authors13-15 report- Europe. The objective of this retrospective people. It included a sample of 674 ran- ed that sociocultural, socioeconomic, and cross-sectional study was to estimate the domly selected people, aged 20 years or work-related factors (eg, poor job satisfac- 6-month prevalence and severity of low older, stratified on sex, age, socioeconomic tion and psychological stress at work) not back pain and sciatica in a representative status, and employment. Information was previously investigated may contribute to sample of a general adult Mediterranean collected by means of structured personal low back pain prevalence and intensity.16-22 population. interviews conducted by 2 of the authors A patient’s culture may also affect not only (P.K., T.R.) after written consent was ob- the likelihood of reporting low back pain, MATERIALS AND METHODS tained from all participants. The interview but also the perception and intensity of low This study was conducted between Oc- was based on a questionnaire that included back pain.23,24 tober 2005 and May 2006 in a prefecture 26 questions that elicited the following e1776 ORTHOPEDICS | Healio.com/Orthopedics LOW BACK PAIN AND SCIATICA | KOROVESSIS ET AL information: demographics (ie, age, sex, nationality), socioeconomic parameters, Table 2 employment variables (ie, work status and LBP and Sciatica Data and Medical Sequences (N5674) type of work), health-related parameters (ie, smoking and depression), reported Parameter No. (%) Parameter No. (%) individual history of low back pain and Reported LBP in Examination sciatica in the past 6 months, and medical past 6 mo None 510 (75.7) sequences (Tables 1, 2). No 408 (60.5) Plain radiographs 84 (12.5) The section of the questionnaire refer- ring to low back pain and sciatica pain Yes 266 (39.5) CT scan 34 (5.0) intensity (using the visual analog scale Reported sciatica in MRI 46 (6.8) past 6 mo [VAS]) was validated by the authors dur- Medication ing a 2-week interval using 50 people who No 508 (75.4) No 575 (85.3) consented to participate in this evaluation. Yes 166 (24.6) Yes 99 (14.7) To compare with other variables, pain in- LBP intensity, VAS Medication duration, d tensity was categorized into 4 categories: No pain 408 (60.5) 1-10 56 (56.6) VAS score of 05no pain; VAS score of 1 to 1 15 (2.2) 11-30 34 (34.3) 35mild pain; VAS score of 4 to 75mod- 2 20 (3.0) 45-180 9 (9.1) erate pain; and VAS score of 8 to 105se- 3 34 (5.0) Physical therapy vere pain (Tables 3, 4). No clinical evalu- ation for sciatica and low back pain was 4 27 (4.0) No 632 (93.8) performed because physical examinations 5 40 (5.9) Yes 42 (6.2) were not in the scope of this study. 6 35 (5.2) Bed rest in past 6 mo Low back pain was considered pain 7 26 (3.9) No 597 (88.6) and discomfort localized below the costal 8 27 (4.0) Yes 77 (11.4) margin and above the inferior gluteal folds, 9 20 (3.0) Time in bed, d and sciatica considered pain, numbness, or 10 22 (3.3) 1-7 46 (59.7) tingling radiating in the posterior surface of Sciatica intensity, VAS 8-30 28 (36.4) the leg. No pain 508 (75.4) 31-60 3 (3.9) Statistical Analysis 1 20 (3.0) Abstain from work Analysis was performed using Stata/ 2 19 (2.8) No 609 (90.3) SE version 11.0 software (StataCorp LP, 3 16 (2.4) Yes 65 (9.7) College Station, Texas). 4 21 (3.1) Time abstained from work, d Frequency distributions of responses 5 16 (2.4) 1-30 56 (86.2) and cross-tabulations of demographic, 6 19 (2.8) 31-60 8 (12.3) socioeconomic, and employment analysis 7 13 (1.9) 61-120 1 (1.5) with reported history of low back pain and 8 19 (2.8) Hospital admission in past y sciatica were examined. For each question 9 9 (1.3) No 656 (97.4) specified, associations of demographic, 10 14 (2.1) Yes 18 (2.6) socioeconomic, and employment variables with low back pain and sciatica intensity Medical help requested Surgery for LBP or sciatica were tested by univariate and multivariate No 530 (78.6) No 661 (98.1) logistic regression. Odds ratios (ORs) and Yes 144 (21.4) Yes 13 (1.9) 95% confidence intervals were estimated.
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