First EFIC® Symposium Societal Impact of Pain - SIP

52
Ewald Gspurning, MPH
Ewald Gspurning
Styrian Back Pain Survey
Currently the discussions about rationing and
rationalisation of solid financed services in the
health care system are taking place in Austria,
as well as in many other western industrial
countries. The increase of chronic diseases is
a topic often at the top of the agenda and is
currently a great expense factor in the health
service. Chronic back pain is still a medical and
health-political challenge because of the high
occurrence rates in the western industrial population.
Furthermore, chronic back pain in a
context of a political and ethical dimension of
public health raises questions about values in
our society such as a fair distribution of limited
resources, the responsibility of the stakeholders
and the basis of their information and
knowledge, the impact of system changes on
the health-related quality of life and the costbenefit
ratio.
The aim of the survey was the generation of
statistical information about the epidemiology,
the time course and the associated risk factors
of the „common disease“ back pain in Styria,
which is one of nine states in Austria with a
population of about 1.2 million.
The “Styrian Back Pain Survey” is a regional
population-based postal survey of 12,000 randomly
chosen, age and gender-matched persons
of the Styrian general population conducted
from April to June 2008. The selection
of the surveyed people between the ages of
19 and 79 years was carried out on the basis
of documentation files of the social health insurance
of the state of Styria.
The survey delivers a cross sectional snap shot
of the prevalence of back pain as well as gender-related
and age-related distribution of back
pain in the Styrian population. In addition, an
analysis of possible factors, which influence the
utilization of the health care system, is performed.
On the one hand, the report delivers
actual data about the correlation between LBP
and demographic characteristics, individual
lifestyle, subjective locus of control, quality of
life and on the other hand findings about the
level of satisfaction with the present back pain
treatment.
The results of the survey showed a high number
of one-year prevalence of back pain (male:
61.4% - female 58.6%) among the Styrian population.
More than one in five adults in Styria
(21.5%) suffered from chronic back pain last
year. Statistics showed only slight genderspecific
differences.
The variables like age and education have a
strong influence on the clinical picture and
health care utilization. The percentage of individuals
with chronic pain in the group of the
+60 year olds is six times higher than in the
group of the under 30 year olds. There is also
a big difference in the prevalence of chronic
back pain between individuals with the lowest
education (26.5%) and highest education
(15%). Less than half of the patients (48.1%)
with back pain consult a doctor and most of
them a general practitioner. Approximately
10% of patients with chronic back pain changed
their physician more than three times during
the last year as a result of ineffective pain treatment.
In a nutshell many findings of the survey have
been known for a long time. We see that individuals
of higher age, lower education, overweight
and a pronounced “external locus of
control” have a stronger inclination to chronic
course of pain. Moreover, the type and the
terms of employment, the job characteristics
and the socio-economic and the psycho-social
aspects showed a narrow correlation with appearance
and the course of back pain. On the
contrary, no significant connection was found
between back pain and smoking.
The information of the Styrian back pain
report is an inalienable constituent part of a
responsible health care policy and offers a technical
basis for the paradigm change in the
current growing scarcity of financial resources
in health care systems. This change demands
political courage. It is necessary to denounce
the prevalence and incidence of back pain by
more state-of-the-art and effective methods,
on the one hand by prevention measures and
on the other hand by new interdisciplinary
methodological approaches of pain treatment
to enhance efficacy. At least our common main
objective must be to reduce the burden of people
suffering from chronic back pain.