Welcome back to Spine IQ’s Back Blog! This week, we would like to discuss a study looking at one factor that should be of interest to spine clinicians everywhere in today’s world – the intersection of low back pain (LBP) and the COVID-19 pandemic.1 “Chronic low back pain during COVID-19 lockdown: is there a paradox effect?” by Amelot et al. evaluated the impact of lockdown during the pandemic on chronic LBP and potential factors that influence its prognosis.2
Countries enacted stay-at-home orders and lockdowns in order to reduce the spread of COVID-
- Evidence suggests these policies are effective in reducing transmission of infectious disease3–6, however they may have a negative influence on anxiety, depression, physical activity, and social isolation.7,8 All of these factors have also been suggested to disproportionately impact patients with chronic LBP.9,10 Therefore, the purpose of this study was to examine the prognosis of chronic low back pain during lockdown and evaluate potential factors of influence.
During the beginning of the COVID-19 pandemic (March – June 2020), while most countries were on lockdown, 50 chronic low back pain patients in France were included in a case series and prospectively followed. These patients were assessed at baseline and then again one month after lockdown policies were lifted in France. Scientists collected data on demographics (age, sex, medical history, body mass index, pharmacological history etc.), back pain management (in-person clinical care, at-home exercise, pharmacological analgesia), back pain function (Oswestry Disability Index [ODI]), and pain (visual analogue scale [VAS]).
The majority of patients (96%) had to stop attending in-person clinical care during this time period, however 70.3% reported continuing to perform their home exercise program. Half of patients reported increasing the number of pharmacological analgesics taken, meanwhile 30% decreased their intake. Patients were separated into three back pain groups – improved back pain (36%), worse back pain (28%), and no change in back pain (36%).
The improved back pain group had a significant reduction in mean ODI score (26.5%) and VAS by 3.9 points. The worse back pain group had a significant increase in mean ODI score (19.1%) and VAS by 2.2 points. The group with unchanged back pain saw no significant difference in mean ODI score (0.3%) or VAS (0.8 points). Out of the factors analyzed, only home exercise and low COVID-19 related anxiety were significantly associated with improved prognosis of chronic LBP. Meanwhile, history of taking benzodiazepines prior to lockdown and not doing home exercise were significantly associated with worsening prognosis of chronic low back pain. It is important to acknowledge the limitation of small sample size (n = 50) in this study, however these results are similar to other small studies that evaluated back pain during the COVID=19 pandemic.11,12
The global emergency of a highly infectious disease resulted in many countries taking measures to help reduce the impact and mortality. However, these policies may influence noncommunicable diseases, such as LBP. It is important for clinicians to keep this in mind regardless of what happens with this or future pandemics. Some patients are still wary or not able to access in-person clinical care. Ensuring that patients have a home exercise program that aligns with their goals, created through shared decision making between patient and doctor, and have access to interventions or clinicians that may be able to help with anxiety is imperative to increase the likelihood of improved prognosis. Our blog on how to build a successful self-management plan is a good place to find tips on home exercise programming. Several small studies report benefits of exercise and communication with the provider however, larger studies are needed to confirm any effects. In the meantime, this study is another indication that exercise seems to have a positive impact on patients with LBP.
- GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Lond Engl. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9
- Amelot A, Jacquot A, Terrier LM, et al. Chronic low back pain during COVID-19 lockdown: is there a paradox effect? Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. Published online November 2, 2021. doi:10.1007/s00586-021-07049-y
- Redlberger-Fritz M, Kundi M, Aberle SW, Puchhammer-Stöckl E. Significant impact of nationwide SARS-CoV-2 lockdown measures on the circulation of other respiratory virus infections in Austria. J Clin Virol Off Publ Pan Am Soc Clin Virol. 2021;137:104795. doi:10.1016/j.jcv.2021.104795
- Davies NG, Barnard RC, Jarvis CI, et al. Association of tiered restrictions and a second lockdown with COVID-19 deaths and hospital admissions in England: a modelling study. Lancet Infect Dis. 2021;21(4):482-492. doi:10.1016/S1473-3099(20)30984-1
- Guzzetta G, Riccardo F, Marziano V, et al. Impact of a Nationwide Lockdown on SARS-CoV-2 Transmissibility, Italy. Emerg Infect Dis. 2021;27(1). doi:10.3201/eid2701.202114
- Angoulvant F, Ouldali N, Yang DD, et al. Coronavirus Disease 2019 Pandemic: Impact Caused by School Closure and National Lockdown on Pediatric Visits and Admissions for Viral and Nonviral Infections-a Time Series Analysis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2021;72(2):319-322. doi:10.1093/cid/ciaa710
- Dor-Haim H, Katzburg S, Revach P, Levine H, Barak S. The impact of COVID-19 lockdown on physical activity and weight gain among active adult population in Israel: a cross-sectional study. BMC Public Health. 2021;21(1):1521. doi:10.1186/s12889-021-11523-z
- Abbott A. COVID’s mental-health toll: how scientists are tracking a surge in depression. Nature. 2021;590(7845):194-195. doi:10.1038/d41586-021-00175-z
- Alhowimel A, AlOtaibi M, Radford K, Coulson N. Psychosocial factors associated with change in pain and disability outcomes in chronic low back pain patients treated by physiotherapist: A systematic review. SAGE Open Med. 2018;6:2050312118757387. doi:10.1177/2050312118757387
- Bohman T, Alfredsson L, Hallqvist J, Vingård E, Skillgate E. The influence of self-reported leisure time physical activity and the body mass index on recovery from persistent back pain among men and women: a population-based cohort study. BMC Public Health. 2013;13(1):385. doi:10.1186/1471-2458-13-385
- Šagát P, Bartík P, Prieto González P, Tohănean DI, Knjaz D. Impact of COVID-19Quarantine on Low Back Pain Intensity, Prevalence, and Associated Risk Factors among Adult Citizens Residing in Riyadh (Saudi Arabia): A Cross-Sectional Study. Int J Environ Res Public Health. 2020;17(19):E7302. doi:10.3390/ijerph17197302
- Borsa S, Pluderi M, Carrabba G, et al. Letter to the Editor: Impact of COVID-19 Outbreak on Acute Low Back Pain. World Neurosurg. 2020;139:749. doi:10.1016/j.wneu.2020.05.218