DISABILITY AMONG PERSONS WITH CHRONIC SEVERE BACK PAIN: RESULTS FROM A NATIONALLY REPRESENTATIVE POPULATION-BASED SAMPLE

D. Ehrmann Feldman¹, R. Nahin²

¹Université de Montréal, School of Rehabilitation, Montreal, Canada, ²National Institutes of Health, National Center for Complementary and Integrative Health, Bethesda, United States

Background: With the high prevalence of back pain and high costs associated with cases that become chronic there has been an emphasis on preventing chronicity. These costs include those related to work disability, assistance for activities of daily living, long-term treatment, and management for chronic pain.

Purpose: We sought to evaluate the association between chronic severe back pain with disability and participation and explore associated factors in American adults, using data from the US 2019 National Health Interview Survey (NHIS). A secondary objective relates to intersectionality theory, which suggests that sociodemographic factors and disability status often interact in their health impact. We explored synergistic effects of race, sex, socioeconomic status (SES) with disability.

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, 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). We performed stratified subgroup analyses for each of the four outcomes by race, ethnicity, sex and SES.

Results: In our sample of 2,925 adults (weighted n: 20,468,134) who reported having chronic severe back pain, 74.8% reported some disability/limitation. Specifically, 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 SES 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 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. Stratified analyses revealed interactions between sex, SES and race/ethnicity when it comes to pain related disability. In those with lower SES, white females and nonHispanic females were less likely to report difficulties with self-care. Hispanic females were more likely to be disability free with respect to working compared to both non-Hispanic females and males.

Conclusions: Amongst those with chronic severe back pain, there is a substantial proportion with disability and reduced social and/or work participation.

Implications: Identifying factors associated with increased likelihood of disability and limitation may help target appropriate pain management regimens for persons at high risk for disability.

Funding acknowledgements: This project did not receive funding.

Keywords:
Chronic severe back pain
Disability
Associated factors

Topics:
Pain & pain management

Did this work require ethics approval? No

Reason: The National Institutes of Health Office of Human Subjects Research Protection authorized an exemption from Institutional Review Board review for the current study because it used publicly available and de-identified data from the NHIS.