Welcome back to SpineIQ’s BackBlog! This week, we are highlighting a WFC-NCMIC Louis Sportelli Research Award winning paper led by Dr. Katie De Luca, titled “The relationship between spinal pain and comorbidity: cross-sectional analysis of community-dwelling, older Australian women.”¹¹ Similar to our previous blogs this month, we are once again honoring Women’s History Month by highlighting important studies led by women investigators.

While we have a lot of research showing the large health and financial burden caused by spine pain.^2,3 There is limited research looking at how spine pain is associated with number and type of comorbidities. This is clinically impactful as a higher number of comorbidities influences prognosis, treatment decisions, and referral or co-management decisions.  While spine care clinicians see patients with multiple comorbid conditions every day, many may not think directly about the correlation between spine pain and other serious comorbidities their patients experience.  An opportunity exists for an easy transition for the clinician to ask several questions during the initial clinical intake history, which may provide huge insight into the overall health and progress.  Therefore, Dr. De Luca and her team sought to understand the relationship between spinal pain and comorbidities.

Objective and Methods

579 participants responded to a survey asking them about spinal pain, health-related quality of life and comorbidities. Presence of spinal pain was determined if participants answered “yes” to the question, “which of your joints have been troublesome (painful, aching, swollen, or stiff) on most days of the past month?” Comorbidity is defined as a medical disease either independent or related to the main disease. The type of comorbidity was determined by both self-report question and hospital data confirmation. The comorbidities were grouped into the following categories:

• cardiovascular disease (heart disease and hypertension),
• pulmonary disease (bronchitis, emphysema, and asthma),
• cancer (breast, bowel, skin, and lung cancers)
• mental disorders (depression, anxiety, and psychiatric illness),
• obesity
• diabetes
• stroke

The Medical Outcomes Study: 36 item short form survey was used to assess health-related quality of life.

Result

Of the 579 participants, 55.8% (n=323) had spinal pain. It is interesting, as well as instructive, to note that participants reporting spinal pain had worse health-related quality of life compared to participants without spinal pain.  Additionally, participants with spinal pain were more likely to have comorbidities compared to people without spinal pain. In fact, people with spinal pain compared to people without spinal pain were significantly more likely by:

• 44 times to have 2 comorbidities
• 07 times to have 3 comorbidities
• 05 times to have 4 comorbidities.

Finally, people with spinal pain compared to people without spinal pain were significantly more likely by:

• 93 times to have diabetes
• 57 times to have cardiovascular disease
• 66 times to have pulmonary disease
• 60 times to have mental disorder
• 98 times to be overweight
• 12 times to have obesity.

Conclusion

As clinicians routinely see in their practice, people with spinal pain are more likely to have comorbidities and be unhealthier compared to people without spinal pain.  This study is an instructive approach to not only educate but make aware of the correlation between spinal pain and co-morbidities, which many patients would not normally associate with spinal pain. Additionally, people with spinal pain reported worse health-related quality of life compared to people without spinal pain. This is important data for conservative spine clinicians to consider as it is essential for clinicians to ask about potential comorbidities for several reasons. First, spinal pain may be stopping patients from being physically active so by decreasing spinal pain and allowing the patient to be more physically active, this can influence these other diseases (e.g., cardiovascular disease and obesity). Second, people with certain comorbidities may be taking certain medications to treat those and some medications given for spinal pain may have unfavorable drug interactions. This places the treatment commonly delivered by conservative spine clinicians (e.g., manual therapy and exercise) as an even more important, first-line treatment. Finally, clinicians may be the first healthcare provider that the patient has seen and therefore, which emphasizes how important it is to properly evaluate patients with spinal pain for other comorbidities given their high correlation with spine pain. This may lead to referral or co-management with other healthcare professionals depending on the suspected comorbidity. This study emphasizes the importance of conservative spine clinicians to continue seeing patients as a whole person, beyond just spinal pain that they may be coming in for.

References:

1. de Luca KE, Parkinson L, Haldeman S, Byles JE, Blyth F. The Relationship Between Spinal Pain and Comorbidity: A Cross-sectional Analysis of 579 Community-Dwelling, Older Australian Women. J Manipulative Physiol Ther. 2017;40(7):459-466. doi:10.1016/j.jmpt.2017.06.004
2. Dieleman JL, Cao J, Chapin A, et al. US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA. 2020;323(9):863-884. doi:10.1001/jama.2020.0734
3. Buchbinder R, van Tulder M, Öberg B, et al. Low back pain: a call for action. The Lancet. 2018;391(10137):2384-2388. doi:10.1016/S0140-6736(18)30488-4