Low Back Pain Usually Co-Occurs With Neck, Shoulder, Hip, and/or Thigh Pain

Approximately 90% of adults with persistent lower back pain have concommitant persistent musculoskeletal (MSK) pain, most commonly in the neck, shoulders, hips, and/or thighs, according to study findings published in the journal Pain.

Researchers in Norway sought to describe the prevalence and patterns of co-occurring persistent musculoskeletal pain in individuals with persistent low back pain though an analysis of data from population-based regional studies administered over the course of 3 decades.

The researchers examined data collected during 3 time periods from the HUNT study, a population-based study of adults in the Nord-Trøndelag region in Norway, in which residents are invited to respond to a series 4 consecutive questionnaires. The analysis included a total of approximately 36,000 participants from 3 HUNT studies who reported persistent low back pain during 3 time periods: 1995 to 1997 (n=15,375), 2006 to 2008 (n=10,024), and 2017 to 2019 (n=10,647).

More than 90% of participants reported persistent musculoskeletal pain in other parts of the body as well as the low back. In the current analysis, the researchers used latent class analysis to identify 4 patterns of pain co-occurrence. These 4 patterns with their conditional item response probabilities included: (1) low back pain only: 34% to 36%; (2) low back pain with neck or shoulder pain: 30% to 34%; (3) low back pain with lower extremity or wrist or hand pain: 13% to 17%; and (4) low back pain with multiple sites of co-existing pain: 16% to 20%.

The age-standardized prevalence of the most common pain sites was consistent for the 3 time periods. Among all those studied, low back pain co-occurred most frequently with neck pain (64% -65%), shoulder pain (62% to 67%), and hip or thigh pain (53% to 57%).

Study limitations include the lack of ethnic diversity among study participants, which limited the generalizability of the study’s results; the potential reporting bias and measurement error; and a change in the pain questionnaire and a lower response rate for the second study period.  In addition, attrition during the later study periods could have resulted from selective participation by those with higher socioeconomic status and better health than the general population.

“About 9 of 10 adults with persistent LBP experience co-occurring persistent MSK pain, most commonly in the neck, shoulders, and hips or thighs. These findings support that persistent LBP seldom presents itself as a single-site pain condition and that people can

be classified into stable clinically meaningful pain phenotypes that may have relevance for stratified clinical care approaches,” the study authors stated. “[B]oth the prevalence and pattern of co-occurring MSK pain and the distinct phenotypic MSK pain patterns seem stable over decades,” the researchers added.

This article originally appeared on Clinical Pain Advisor