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Back Pain in the German Adult Population: Prevalence, Severity, and Sociodemographic Correlates in a Multiregional Survey

Schmidt, Carsten Oliver, MD*; Raspe, Heiner, PhD; Pfingsten, Michael, PhD; Hasenbring, Monika, PhD§; Basler, Heinz Dieter, PhD; Eich, Wolfgang, PhD; Kohlmann, Thomas, PhD*

doi: 10.1097/BRS.0b013e318133fad8
Health Services Research

Study Design. A population-based cross-sectional multiregion postal survey.

Objective. To provide a descriptive epidemiology of the prevalence and severity of back pain in German adults and to analyze sociodemographic correlates for disabling back pain within and across regions.

Summary of Background Data. Back pain is a leading health problem in Germany. However, comprehensive population-based evidence on the severity of back pain is still fragmentary for this country. Despite earlier findings concerning large prevalence differences across regions, systematic explanations remain to be ascertained.

Methods. Questionnaire data were collected for 9263 subjects in 5 German cities and regions (population-based random samples, postal questionnaire). Point, 1-year, and lifetime prevalence were assessed using direct questions, and graded back pain was determined using the Graded Chronic Pain Scale. Poststratification was applied to adjust for cross-regional sociodemographic differences.

Results. Point-prevalence was 37.1%, 1-year prevalence 76.0%, and lifetime prevalence 85.5%. A substantial minority had severe (Grade II, 8.0%) or disabling back pain (Grade III–IV, 11.2%). Subjects with a low educational level reported substantially more disabling back pain. This variable was an important predictor for large cross-regional differences in the burden of back pain.

Conclusion. Back pain is a highly prevalent condition in Germany. Disabling back pain in this country may be regarded as part of a social disadvantage syndrome. Educational level should receive greater attention in future cross-regional comparisons of back pain.

This population-based cross-sectional multiregion postal survey provides a descriptive epidemiology of back pain in German adults and analyzes sociodemographic correlates of disabling back pain. Back pain prevalence and severity differed substantially across regions. Educational level was an important predictor for back pain and accounted for prevalence differences between regions.

From the *Institute of Community Medicine, University of Greifswald, Greifswald, Germany; †Institute of Social Medicine, University Clinics Lübeck, Lübeck, Germany; ‡Pain Ambulance, Center for Anaesthesiology, Emergency and Intensive Medicine, University of Göttingen, Göttingen, Germany; §Department of Medical Psychology and Sociology, Ruhr University Bochum, Bochum, Germany; ∥Institute of Medical Psychology, University of Marburg, Marburg, Germany; and ¶Department of Internal Medicine II, University Hospital Heidelberg, Heidelberg, Germany.

Acknowledgment date: October 10, 2006. First revision date: February 3, 2007. Acceptance date: February 12, 2007.

The German National Back Pain Study is funded by the German Ministry of Education and Research grant 01 EM 011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Carsten Oliver Schmidt, Methoden der Community Medicine, Institut für Community Medicine, Walther Rathenau Str. 48, 17487 Greifswald, Germany; E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.