The objective of this systematic review was to examine whether back pain is associated with increased mortality risk and, if so, whether this association varies by age, sex, and back pain severity.

A systematic search of published literature was conducted and English-language prospective cohort studies evaluating the association of back pain with all-cause mortality with follow-up periods >5 years were included. Three reviewers independently screened studies, abstracted data, and appraised risk of bias using the Quality in Prognosis Studies (QUIPS) tool. A random-effects meta-analysis estimated combined odds ratios (OR) and 95% confidence intervals (CI), using the most adjusted model from each study. Potential effect modification by a priori hypothesized factors (age, sex, and back pain severity) was evaluated with meta-regression and stratified estimates.

Eleven studies with a total of 81,337 participants were included. Follow-up periods ranged from 5 to 23 years. The presence of any back pain, compared to none, was not associated with an increase in mortality (OR, 1.06; 95% CI, 0.97 to 1.16). However, back pain was associated with mortality in studies of women (OR, 1.22; 95% CI, 1.02 to 1.46) and among adults with more severe back pain (OR, 1.26; 95% CI, 1.14 to 1.40).

The authors concluded that back pain was associated with a modest increase in all-cause mortality among women and those with more severe back pain.

I bet that back pain is associated with hundreds of things. The question is whether there might be a causal association; could it be that people die earlier BECAUSE of back pain?

Unless someone’s back pain is so unbearable that she commits suicide, I cannot see how the two can be directly linked in a cause/effect relationship. But there could be indirect causal links. For instance, certain cancers can cause both back pain and death. Or someone’s back pain might make him take treatment against a life-threatening condition less seriously and thus hasten his death.

It has also occurred to me that chiropractors might jump on the bandwagon and use the association between back pain and mortality for boosting their business. Something like this:

Back pain is a risk factor for premature death.

Come to us, and we treat your back pain.

This will make you live longer.

Chiropractic prolongs life!

That would, of course, be daft. Firstly, chiropractic is not all that effective for back pain (or anything else). Secondly, getting rid of back pain is unlikely to prolong your life.

Correlation is not causation!


10 Responses to Back pain is associated with increased mortality – but what does that mean?

  • As you say, there are many possible reasons for a correlation. I would imagine that non-steroidal anti-inflammatory drugs are the main factor. They are commonly prescribed for back pain, and some (such as ibuprofen in the UK) are available over the counter. They are well-known to cause gastrointestinal haemorrhage, and less commonly perforation, and therefore also iron-deficiency. Long-term use leads to kidney damage and an increased risk of acute coronary thrombosis.

    In my view any study of this kind which does not control for NSAID use is unlikely to be reliable when it comes to detecting weaker associations.

  • I would say that the pain in the buttocks that chiropractors experience from your observations could certainly be fatal to them !

    • No pain here because he rarely provides any meaningful insight and often fails to display a comprehensive understanding of the topic. Heck, apparently he can’t even differentiate between chiropractic and spinal manipulation.

  • EE, you are seriously scraping the bottom of the barrel for things to criticize the chiropractic profession about. Your final comments are purely supposition, based upon your own biasness and lack of research (again). Your school report card would read, “Bases most of his assertions on ignorant rhetoric, without providing peer reviewed references to validate his claims”.
    Once again you get an “E” for effort.

  • EE: “chiropractic is not all that effective for back pain”

    Chiropractic is a multimodal approach using such things as spinal manipulation, rehab, exercise, lifestyle modification, ergonomics, etc. Pragmatic studies indicate it is just as good (perhaps better) than what the medical model offers and often less expensive with less risk.

    As far as the study, I agree with Julian on the NSAIDs (and other pain meds i.e.opioids). One also needs to know if the back pain is primary, secondary or tertiary.

    Simply put, it is a review of baseline studies.

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