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Psychosocial Factors in the Workplace-Do They Predict New Episodes of Low Back Pain?: Evidence From the South Manchester Back Pain Study

Papageorgiou, Ann C., MSc*; Macfarlane, Gary J., MD*; Thomas, Elaine, MSc*; Croft, Peter R., MD; Jayson, Malcolm I. V., MD; Silman, Alan J., MD*

Health Services Research/Survey

Study Design. A prospective, population-based cohort study of working adults.

Objectives. To determine whether work-related psychosocial factors and social status predict the occurrence of new episodes of low back pain and influence consultation behavior.

Summary and Background Data. Dissatisfaction with work and social status has been associated with low back pain in several studies; few of these studies have been prospective or population based.

Methods. An initial postal survey was returned by 4,501 (59%) adults (18-75 years old) registered with two primary care practices. From this, a cohort of 1,412 people currently in employment and free of low back pain was identified, and baseline information on work-related psychosocial factors and psychologic distress was obtained. Social class was derived from current occupation using a standardized classification. New episodes of low back pain occurring in the next 12 months were identified by continuous monitoring of primary care consulters and by mailing a second questionnaire a year later to identify occurrences of low back pain for which no consultation was sought.

Results. The baseline cross-sectional survey showed modest but significant associations between low back pain and perceived inadequacy of income (risk ratio 1.3), dissatisfaction with work (risk ratio 1.4) and social class IV/V (risk ratio 1.2). In the follow-up year, the risk of reporting low back pain for which no consultation was sought doubled in those dissatisfied with their work. Both perceived inadequacy of income (odds ratio 3.6) and social class IV/V (odds ratio 4.8) were strongly associated with consulting with a new episode of low back pain during the follow-up year, an association more marked in women. The associations with work dissatisfaction and perceived adequacy of income were not explained by general psychologic distress or social status.

Conclusion. People dissatisfied with work are more likely to report low back pain for which they do not consult a physician, whereas lower social status and perceived inadequacy of income are independent risks for working people to seek consultation because of low back pain.

From the *ARC Epidemiology Research Unit, University of Manchester, Manchester, United Kingdom, the †University of Keele, School of Postgraduate Medicine, Industrial and Community Research Centre, Stoke-on-Trent, United Kingdom, and the ‡Rheumatic Diseases Centre, Hope Hospital, Manchester, United Kingdom.

Supported by grants from the Arthritis and Rheumatism Council, Chesterfield, United Kingdom, and the National Back Pain Association, Teddington, United Kingdom.

Acknowledgment date: May 15, 1996.

First revision date: September 3, 1996.

Second revision date: December 16, 1996.

Acceptance date: December 23, 1996.

Device status category: 1.

Address reprint requests to Ann C. Papageorgiou, MSc; ARC Epidemiology Research Unit; University of Manchester; Stopford Building; Oxford Road; Manchester M13 9PT, United Kingdom

© 1997 by Lippincott Williams & Wilkins