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      Association between chronic low back pain and degree of stress: a nationwide cross-sectional study

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          Abstract

          Low back pain (LBP) is a very common health problem worldwide, and has a major impact on quality of life. This is a cross-sectional study using data obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) to investigate the health and nutritional status of Korean people, conducted in 2013, 2014, and 2015. The total of 8,473 patients included in the analysis. A 357 (19.34%) subjects in the chronic LBP group and 1,697 (25.61%) subjects in the no chronic LBP group reported no stress ( P < 0.001). The numbers of subjects reporting mild, moderate, and severe stress in the two groups were 934 (50.6%) vs. 3,785 (57.11%), 432 (23.4%) vs. 910 (13.73%), and 123 (6.66%) and 235 (3.55%), respectively (all P < 0.001). Multiple logistic regression analysis with full adjustment for other variables indicated higher OR for severe stress (OR 2.82, P < 0.001) than moderate (OR 2.54, P < 0.001) and mild (OR 1.55, P < 0.001) stress. We confirmed that there was a significant association between chronic LBP and degree of stress. Therefore, the degree of stress should be assessed in clinical treatment of chronic LBP patients.

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          Most cited references21

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          Stress, Adaptation, and Disease: Allostasis and Allostatic Load

          Adaptation in the face of potentially stressful challenges involves activation of neural, neuroendocrine and neuroendocrine-immune mechanisms. This has been called "allostasis" or "stability through change" by Sterling and Eyer (Fisher S., Reason J. (eds): Handbook of Life Stress, Cognition and Health. J. Wiley Ltd. 1988, p. 631), and allostasis is an essential component of maintaining homeostasis. When these adaptive systems are turned on and turned off again efficiently and not too frequently, the body is able to cope effectively with challenges that it might not otherwise survive. However, there are a number of circumstances in which allostatic systems may either be overstimulated or not perform normally, and this condition has been termed "allostatic load" or the price of adaptation (McEwen and Stellar, Arch. Int. Med. 1993; 153: 2093.). Allostatic load can lead to disease over long periods. Types of allostatic load include (1) frequent activation of allostatic systems; (2) failure to shut off allostatic activity after stress; (3) inadequate response of allostatic systems leading to elevated activity of other, normally counter-regulated allostatic systems after stress. Examples will be given for each type of allostatic load from research pertaining to autonomic, CNS, neuroendocrine, and immune system activity. The relationship of allostatic load to genetic and developmental predispositions to disease is also considered.
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            Data Resource Profile: The Korea National Health and Nutrition Examination Survey (KNHANES)

            The Korea National Health and Nutrition Examination Survey (KNHANES) is a national surveillance system that has been assessing the health and nutritional status of Koreans since 1998. Based on the National Health Promotion Act, the surveys have been conducted by the Korea Centers for Disease Control and Prevention (KCDC). This nationally representative cross-sectional survey includes approximately 10 000 individuals each year as a survey sample and collects information on socioeconomic status, health-related behaviours, quality of life, healthcare utilization, anthropometric measures, biochemical and clinical profiles for non-communicable diseases and dietary intakes with three component surveys: health interview, health examination and nutrition survey. The health interview and health examination are conducted by trained staff members, including physicians, medical technicians and health interviewers, at a mobile examination centre, and dieticians’ visits to the homes of the study participants are followed up. KNHANES provides statistics for health-related policies in Korea, which also serve as the research infrastructure for studies on risk factors and diseases by supporting over 500 publications. KCDC has also supported researchers in Korea by providing annual workshops for data users. KCDC has published the Korea Health Statistics each year, and microdata are publicly available through the KNHANES website (http://knhanes.cdc.go.kr).
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              The Epidemiology of low back pain.

              Low back pain is an extremely common problem that most people experience at some point in their life. While substantial heterogeneity exists among low back pain epidemiological studies limiting the ability to compare and pool data, estimates of the 1 year incidence of a first-ever episode of low back pain range between 6.3% and 15.4%, while estimates of the 1 year incidence of any episode of low back pain range between 1.5% and 36%. In health facility- or clinic-based studies, episode remission at 1 year ranges from 54% to 90%; however, most studies do not indicate whether the episode was continuous between the baseline and follow-up time point(s). Most people who experience activity-limiting low back pain go on to have recurrent episodes. Estimates of recurrence at 1 year range from 24% to 80%. Given the variation in definitions of remission and recurrence, further population-based research is needed to assess the daily patterns of low back pain episodes over 1 year and longer. There is substantial information on low back pain prevalence and estimates of the point prevalence range from 1.0% to 58.1% (mean: 18.1%; median: 15.0%), and 1 year prevalence from 0.8% to 82.5% (mean: 38.1%; median: 37.4%). Due to the heterogeneity of the data, mean estimates need to be interpreted with caution. Many environmental and personal factors influence the onset and course of low back pain. Studies have found the incidence of low back pain is highest in the third decade, and overall prevalence increases with age until the 60-65 year age group and then gradually declines. Other commonly reported risk factors include low educational status, stress, anxiety, depression, job dissatisfaction, low levels of social support in the workplace and whole-body vibration. Low back pain has an enormous impact on individuals, families, communities, governments and businesses throughout the world. The Global Burden of Disease 2005 Study (GBD 2005) is currently making estimates of the global burden of low back pain in relation to impairment and activity limitation. Results will be available in 2011. Further research is needed to help us understand more about the broader outcomes and impacts from low back pain. 2010 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                brayden0819@daum.net
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                15 July 2021
                15 July 2021
                2021
                : 11
                : 14549
                Affiliations
                [1 ]GRID grid.412678.e, ISNI 0000 0004 0634 1623, Department of Emergency Medicine, , Soonchunhyang University Bucheon Hospital, ; 170 Jomaru-ro, Bucheon, 14584 Republic of Korea
                [2 ]GRID grid.412678.e, ISNI 0000 0004 0634 1623, Department of Orthopaedic Surgery, , Soonchunhyang University Bucheon Hospital, ; 170 Jomaru-ro, Bucheon, 14584 Republic of Korea
                [3 ]GRID grid.412678.e, ISNI 0000 0004 0634 1623, Department of Biostatistics, Clinical Trial Center, , Soonchunhyang University Bucheon Hospital, ; 170 Jomaru-ro, Bucheon, 14584 Republic of Korea
                Article
                94001
                10.1038/s41598-021-94001-1
                8282867
                34267269
                163fc523-1b55-4d47-bb02-2a08db73fe97
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 31 March 2021
                : 5 July 2021
                Funding
                Funded by: Soonchunhyang University Research Fund
                Categories
                Article
                Custom metadata
                © The Author(s) 2021

                Uncategorized
                health care,risk factors
                Uncategorized
                health care, risk factors

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