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Low Back Pain in Iran: A Growing Need to Adapt and Implement Evidence-Based Practice in Developing Countries

Mousavi, Sayed Javad, PhD*; Akbari, Mohammad Esmaeil, MD; Mehdian, Hossein, MD, FRCS(Ed); Mobini, Bahram, MD§; Montazeri, Ali, MPH, PhD, FFPH; Akbarnia, Behrouz, MD∥,**; Parnianpour, Mohamad, PhD††,‡‡

doi: 10.1097/BRS.0b013e3181fa1da2
Literature Review

Study Design. A descriptive overview of the literature.

Objective. To present a comprehensive descriptive overview of the published papers about epidemiologic features, burden, and current management of low back pain (LBP) in Iran.

Summary of Background Data. Little is known about the epidemiology, burden, and management of LBP in developing and low- to middle-income countries, such as Iran.

Methods. A literature search was carried out using MEDLINE database to assess existing literature about prevalence, disease burden, impact, and current management of nonspecific LBP in Iran.

Results. Twenty-six articles matched inclusion criteria and included in the study. The findings related to point, period, and lifetime prevalence of LBP in general population, working population, school children, and pregnant women ranged from 14.4% to 84.1%. The 1-year incidence of disabling LBP was found to be 2.1%. LBP is the third leading cause of disease burden (measured by Disability Adjusted Life Years) in Iranian population aged 15 to 69 years, without considering causes of intentional and unintentional injuries. High levels of anxiety and depression among patients with LBP and the etiological role of job strain in causing LBP in workers have been reported in Iran. Our search failed to find anyarticles about referral system, direct and indirect costs, social determinants, and current management of LBP in Iran.

Conclusion. This overview of the literature illustrates that LBP is a common symptom and an important cause of disease burden in Iran, in particular, in the most productive age for both males and females. The 1-year incidence of disabling LBP in Iran was found to be low. Future research will be necessary to investigate economic cost, social determinants, health technology assessment, and management of LBP in Iran.

Little is known about low back pain in developing countries, such as Iran. This review was an initial step toward describing the epidemiology, burden, and management of LBP in Iran. It highlighted high prevalence and burden of low back pain in a middle-income country such as Iran.

*Department of Physical Therapy, Faculty of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran

Department of Surgery, Cancer Research Center, Shahid Beheshti University (Medical Component), Tehran, Iran

Centre for Spinal Studies and Surgery, Queen's Medical Centre Campus, Nottingham University Hospital NHS Trust, Nottingham, UK

§Department of Spine Surgery, Shafa Yahyaiian Hospital, Tehran University of Medical Sciences, Tehran, Iran

Department of Mental Health, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran

Department of Orthopaedics, University of California, San Diego

**San Diego Center for Spinal Disorders, LA Jolla, CA

††Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran

‡‡Information and Industrial Engineering, Hanyang University, Ansan, Gyunggi, Republic of Korea

Address correspondence and reprint requests to Sayed Javad Mousavi, PhD, Department of Physical Therapy, Faculty of Rehabilitation Sciences, Tehran University of Medical Sciences, Pich-e-Shemiran, Enghelab Ave., Tehran, Iran; E-mail:

Acknowledgment date: July 23, 2009. First Revise date: December 30, 2009. Second Revise date: June 27, 2010. Third Revise date: July 28, 2010. Accepted date: August 23, 2010.

Supported by “Bonyad Melli Nokhbegan” and Tehran University of Medical Sciences; Grant no 88-03-32- 9122.

© 2011 Lippincott Williams & Wilkins, Inc.