Discrepancy between disability and the severity of low back pain: Demographic, psychologic, and employment-related factors

Study Design. Survey of a random sample of all registered residents of Japan between the ages of 20 and 79 years (n = 2966), focusing on those who had had low back pain (LBP) within the past month (n = 906). Objective. To learn more about the characteristics of people in whom the severity of LBP and the disability attributed to that pain are discrepant. Summary of Background Data. LBP can cause disability, but levels of pain and of disability can be discrepant. Some people with severe pain are only slightly disabled, some with mild pain are very disabled, and others have no such discrepancy. Methods. Severity of LBP was measured with a visual analog scale. Disability was measured with the Roland-Morris Disability Questionnaire, which quantifies disability in many daily activities, not necessarily disability related to employment. The respondents also provided demographic information, and completed the SF-36 and questionnaires about perceived stress, employment, and satisfaction with employment. Results. In about 45% of those patients with LBP, the severity of the pain and level of disability attributed to that pain were discrepant. People with a high level of disability despite only mild pain were older, felt more stress, were more depressed, worked more overtime, and were less satisfied with their job content, income, working conditions, and relationships with coworkers. People with little disability despite severe pain were the opposite in all those respects. Conclusions. A group of patients with LBP can be identified for whom the most appropriate interventions should consider psychosocial factors.