Awareness of the German Population of Common Available Guidelines of How to Cope with Lower Back Pain

Background: Several countries developed guidelines in order to provide a systematic approach fortreatment of (chronic) lower back pain. The risk of suffering from (chronic) lower back pain differssignificantly within the general population. A serious lack of research exists concerning the risk factor“dysfunctional behavior of the subjects in terms of acute lower back pain.”Objective: The purpose of this study was to assess the knowledge of the German populationregarding the availability of guidelines about managing lower back pain.Study Design: Prospective observational cohort study.Setting: We interviewed 983 subjects by phone. The study population included 50 – 70-year-oldmen and women with German residency and sufficient language ability.Results: Of all the subjects, 70.2% claimed that they suffered at least once in their lifetime with lower backpain. Lower back pain with radiating symptoms occurred in 28.7%. Women were affected significantlymore frequently compared to the epidemiological data. Of all the subjects with lower education, 82.9%suffered from lower back pain at least once in their lifetime compared to only 62.4% of people withuniversity degrees. Education was also a protective factor for lower back pain with radiating pain. Peoplewho completed secondary modern school were 42% less likely to suffer from lower back pain thanthose who did not graduate. Knowing active rules of conduct occurred significantly more often at highereducational levels (i.e. all kinds of sports and exercises requiring physical strength, flexibility, power, agility,coordination, grace, balance and control, in particular stretching exercises) odds ratio = 7.78, physicalactivities odds ratio = 3.92, relaxation exercises odds ratio = 3.51).Limitations: Data acquisition was performed by an external company and therefore provided onlylimited options for external validity. Furthermore data acquisition was restricted to 50 – 70-year-oldpatients, since this age group is at higher risk of suffering from lower back pain. A conclusion uponthe knowledge of the whole population has to be drawn with caution, especially when consideringthe size of the study population. The life-time prevalence of lower back pain was assessed byinterviewing patients about prior episodes of lower back pain. Slightly biased results may haveoccurred since the memory of prior episodes might result in too many or too few episodes.Conclusion: The study revealed a lack of awareness of common available guidelines and anuneven distribution of existing knowledge throughout the population. Passive coping strategieslike taking pain medication or ointment therapy were favored over active coping strategies likegymnastics, physical activities, and relaxation exercises. Respondents with a higher level of educationsuffered significantly less often from lower back pain and tended toward active treatment strategies.Respondents with lower levels of education more often demanded passive treatment strategies. Thegeneral population, especially those with lower education, is not sufficiently aware of behavioralstrategies for managing lower back pain as proposed in available guidelines.Key words: Treatment guidelines, lower back pain, aged 50 – 70, socioeconomic factors, healthknowledge