Factors associated with seeking medical care for low back pain in a twin adult sample

Abstract

Background: Previous studies have only investigated how symptom presentation and socio-demographic factors influence care-seeking for low back pain (LBP).However, the influence of health and lifestyle factors remains unclear, and the potential confounding effects of aggregated familial factors (including genetics and the early shared environment) has not been considered extensively. Methods: A cross-sectional analysis was performed on 1605 twins enrolled in the Murcia Twin Registry (Spain). The outcome was seeking medical care for LBP and various self-reported demographic, health and lifestyle factors were considered predictors. All variables except sleep quality and diabetes were collected in 2013, which were cross-referenced from 2009 to 2010. A multivariate logistic regression model was performed on the total sample, followed by a co-twin case-control analysis. Results: The only significant factor found to increase the odds of seeking medical care for LBP without being affected by familial factors was poor sleep quality (total sample OR = 1.58, 95%CI 1.24-2.01; case-control OR = 1.75, 95%CI 1.14-2.69).The factors that were associated with reduced odds of seeking medical care for LBP and not confounded by familial factors were male sex (case-control OR = 0.55, 95%CI 0.33-0.93), alcohol intake (case-control OR = 0.90, 95%CI 0.82-0.99) and a history of diabetes (case-control OR = 0.50, 95%CI 0.25-0.97). No other factors significantly influenced medical care-seeking for LBP. Conclusions: People reporting poor sleep quality are more likely to seek medical care for LBP in the long term, with this relationship being independent from aggregated familial factors. Conversely, males, people reporting higher alcohol intake, and people with a history of diabetes are less likely to seek medical care for LBP. Significance: This is the first study investigating the factors that influence seeking medical care for LBP, while adjusting for the influence of familial factors using a co-twin control design. Poor sleep quality is associated with seeking medical care for LBP in the long term and does not appear to be confounded by familial factors. Early screening for indicators of poor sleep quality and appropriate referral to interventions for improving sleep quality or reducing pain in sleep may improve LBP management.

Association between type 2 diabetes and chronic low back pain in general practices in Germany

“…to 1605 twins in the same country, found that a history of diabetes was negatively associated with the odds of seeking medical care for low back pain. 21 Theoretically, diabetes could lead to an increase in the risk of CLBP due to lower muscle mass 22 23 and poor mental health (eg, depression 13 24 ), while diabetes and CLBP share common risk factors such as obesity 25 26 and low-grade systemic inflammation. 27 28 Although previous studies have advanced the field, the majority of these studies were surveys, and the use of self-reported measures may have impacted the validity of their findings.…”

“…In recent years, a significant body of literature has focused on the relationship between diabetes and CLBP, and these studies have reported conflicting results. [14][15][16][17][18][19][20][21] For example, a Spanish study including 2096 twins revealed that type 2 diabetes was cross-sectionally associated with a wide range of back conditions such as severe CLBP and severe chronic spinal pain. 14 A systematic review and metaanalysis of eight studies also showed a positive association between diabetes and both low back and neck pain.…”

“…13 In terms of chronic physical conditions, an increasing body of research has investigated the relationship between diabetes and back pain, but there are some discrepancies in the results of these studies. [14][15][16][17][18][19][20][21] For example, a Spanish case-control study including 4190 individuals with and without diabetes revealed that CLBP and chronic neck pain were more common in people with diabetes. 20 By contrast, another cross-sectional study, using data pertaining…”

The impact of different intensities and domains of physical activity on analgesic use and activity limitation in people with low back pain: A prospective cohort study with a one‐year followup

“…Covariates were chosen based on the potential association between physical activity and analgesic use and activity limitation for LBP. Previous research has shown that activity limitation and analgesic use for LBP can be associated with factors such as pain intensity (Monticone et al, 2021; Oliveira et al, 2019; Patterson et al, 2021; Severeijns et al, 2001; Sturgeon, 2014) and duration (Hayden et al, 2010; Sribastav et al, 2018), depression (Grabovac & Dorner, 2019; Monticone et al, 2021; Oliveira et al, 2019; Pinheiro et al, 2015; Severeijns et al, 2001; Sturgeon, 2014), anxiety (Grabovac & Dorner, 2019; Monticone et al, 2021; Oliveira et al, 2019; Severeijns et al, 2001; Sturgeon, 2014), stress (Grabovac & Dorner, 2019; Severeijns et al, 2001; Sturgeon, 2014), sleep quality (Ho et al, 2021; Kovacs et al, 2018; Patterson et al, 2021), level of disability (Ferreira et al, 2010; Monticone et al, 2021; Oliveira et al, 2019; Severeijns et al, 2001; Sturgeon, 2014), age (Mannion et al, 2013), gender (Ferreira et al, 2010; Ho et al, 2021; Mannion et al, 2013) and body mass index (BMI) (Hashimoto et al, 2018; Miura et al, 2019; Sribastav et al, 2018; Stevans et al, 2021). Therefore, the confounding effects of these aforementioned factors on analgesic use and activity limitation were accounted for in the study analysis.…”