How Back Pain Took Over the World

The biggest cause of disability around the world is surprisingly banal.

Chris Helgren / Reuters

The newest iteration of the Global Burden of Disease study, which tracks the prevalence of deaths and diseases worldwide, contains some good news: On average people are living about a decade longer than they were in 1980. But there’s a catch: Health hasn’t improved as fast as life expectancy overall, which means that for many, those long, final years are spent hobbled by illness and disability.

The nature of our old-age ailments has changed in recent years. The study, published this week in The Lancet and conducted by the Institute for Health Metrics and Evaluation at the University of Washington, uses a metric called “Disability Adjusted Life Years.” DALYs, as they’re abbreviated, combine the number of years of life a person loses if they die prematurely with the amount of time they spend living with a disability. Think of it as time you didn’t spend living your #bestlife—because you were sick or dead.

In rich countries, the number one cause of these DALYs is not surprising: ischemic heart disease, which is associated with well-known Western issues like high cholesterol and obesity. But the number two condition is a little strange: plain, old-fashioned, ever-present, low back and neck pain:

Cause of disability-adjusted life-years in rich nations. (IHME)

Even when you include poor and middle-income countries, low back and neck pain went from ranking 12th as a cause of DALYs globally in 1990 to ranking fourth in 2015, the most recent year. In most countries, it was the leading cause of disability. DALYs from low back and neck pain increased by more than 17 percent from 2005:

Cause of disability-adjusted life-years in all nations. (IHME)

The things that make us low-level miserable are now more likely to be simple aches and pains, rather than frightening, communicable diseases like diarrhea. That’s encouraging, but it’s still a little sad. People all over the world increasingly live long, great lives, only to spend their golden years slathered in IcyHot.

To find out why, I called Theo Vos, a professor of global health at the University of Washington and an author of the Global Burden study. He dismissed my first theory, that computers were causing our musculoskeletal issues. After all, in 1990 far fewer people spent their days glued to a screen, yet back pain was still a major problem. Plus, jobs in the service or agriculture industries are the most likely to cause back pain, the study found—not typing or texting.

Instead, the rising importance of back pain as a cause of disability reveals two important global trends: One, that we’ve gotten better at fighting the types of things that used to really plague people, like measles (down 94 percent globally since 1990). Second, and relatedly, populations around the world are aging. And old peoples’ backs hurt. (Indeed, the rise of back pain looks a lot less dramatic when the numbers are adjusted for age.)

Here’s a chart of how the population of kids in the world has decreased while the number of senior citizens has skyrocketed, and is projected to continue to:

Children and Older People as a Percentage of Global Population

The old-people factor makes sense, when you look at The Lancet study’s spread of countries that are suffering most from back pain. Many of them are aging countries like Germany and Japan:

Years lost to disability to low-back and neck pain, by country. (IHME)

But there are other factors that influence backaches, and those are all getting worse too. A high body-mass index and a lack of physical activity are both risk factors for back pain, and the same institute found a few years ago that obesity and overweight have increased by 28 percent in adults around the world since 1980. Trying to get obesity under control, Vos said, has been “spectacularly unsuccessful.”

It’s much the same story with back pain:  We don’t really know what to do about it. There aren’t good treatments for it, Vos said, and some of the things that people use to try to manage it—like prescription opioids—have only morphed into health crises in their own right.

“For many years, I’ve had a very severe backache, and I don’t really seek care for it because it doesn’t really help,” he said. So it's likely back pain will be with Vos—and many others around the world— “for a long time to come.”