Causes of low back pain (LBP) in women without pregnancy, in relation to different age groups during the reproductive period, are primarily treated as musculoskeletal disorders: A retrospective study

Abstract

Introduction: Low back pain (LBP) is a musculoskeletal disorder of several causes that can mess up the spine. [11] It is characterized by pain, stiffness or muscle tension and is usually localized in the lumber region. – During their working years, people frequently experience low back pain. Approximately 84% of adults experience LBP once or more during their lifetime. [1, 3, 6, 8] In Bangladesh, wt. related prevalence of LBP is 18.5% and age group 18-34 years prevalence are 10.5% and >55 years 27.8%, average 19.2%, which is more in women 27.2% than men. [1] Pain in the Soft tissue of the back is extremely common among adults and often affects individuals during their working years. LBP in women, is strongly linked to hormonal,- and reproductive factors, the work environment and lifestyle. [3] Females frequently experience lower abdominal and back pain at reproductive age, usually due to PMS, PMDD, dysmenorrhea, endometriosis, pregnancy, menopause, muscle spasms, arthritis, UTI, PID, HTN, DM, obesity, multiple C/S tracts and lower abdominal operations, all of which cause RAD, osteoporosis, vertebral and intervertebral disc diseases (PLID, herniation, slipping etc.). [9, 10] The L₄ and L₅ neural arches are involved in the transmission of a considerable load. Therefore, the joints between the articular facets of L₄ and L₅,- are sites of LBP. Low back pain (LBP) was diagnosed by history and clinical examination according to the Pain Scale. To determine the cause of HELLP syndrome/causes by routine investigations and sometimes abdominal ultrasonography (USG), magnetic resonance imaging (MRI) is needed. [3, 8] Treatment of LBP depends on the cause. When a definite lesion is not found, The patient should be informed and reassured about the treatment of LBP. [3] Purpose/Objective of the study: To identify the causes of LBP and prevalence in women of reproductive age except for pregnant individuals and establish referral guidelines. Methodology: This was a retrospective (observational) cross sectional study jointly conducted by Orthopedics and Gynecology Expertise in the North-East region, named the Sylhet Division of Bangladesh. Female patients were considered to be of reproductive age for the last three (3) years (2020 - 2022) at the Z & J fellows' medical institution. The data were collected from the medical records of computer databases with preset questionnaires and written informed consent. The 1^st part of the questionnaire consisted of questions about causes of LBP, and the 2^nd part consisted of LBP-related questionnaires. Patients were selected by the inclusion and exclusion criteria. The data were analyzed with SPSS 25.0 statistical software, MS Word and Excel version 2010. Descriptive statistics were analyzed, i.e. frequency, central tendency and dispersion, i.e. range, standard deviation and variance. Tests of “proportions” and “significance” were performed via sample t-test and ANOVA. Statistical data analysis was used to evaluate the correlation of LBP incidence and intensity (%) with – age, BMI, disease status, marital status, obstetric history, working history and posture of reproductive-age women. Summary: LBP has multiple causes. In retrospective studies, there is no way to predict the prevalence of causes; rather, the prevalence of causes, can be determined before patients are affected. In our study, we found the causes of LBP in women: age, BMI, local and systemic diseases, marriage history, obstetric history and working history with posture. The prevalence of LBP was greater in the 41-50 years age group (34.7%) and in the 20-30 years age group (34.2%). Moreover, overweight and obesity are associated with LBP. Overall 5.3% and 12.8% of the participants were overweight and obese, respectively, and were aged >20-30 years with LBP. Patient age, BMI, disease status, marital status, obstetric history and working history had no effect on any of the patients, but some patients had LBP; overweight, obesity, age group and working posture had direct effects on LBP incidence (p>0.05). LBP is more common in women- than in men and may be due to household activities, and a greater frequency of visceral pain during menstruation, pregnancy and labor. Conclusion: Low back pain (LBP) is effect of multiple physical conditions,- that can occur in women of reproductive age except during pregnancy and can disrupt the back tissues of lumbosacral region. Women are more susceptible to LBP, because of menstrual and obstetric factors. A diagnosis was made by meticulous detailed medical history, physical examination and proper investigations. The parameters (causes) , we found that LBP had no effect on any of the patients, but women of reproductive age may suffer from LBP due to differences in cause. Message of the article: LBP in women of reproductive age except pregnancy is multifactorial effect of back tissues, especially lumber region. LBP has a major socioeconomic impact on patients and leads to disability. Proper evaluations are mandatory to identify the causes of the underlying pathology of pain generators before starting treatment. Patients were referred to an apposite medical person when they met the relevant guidelines; ⅰ) the findings were suggestive of serious medical and psychological issues; ⅱ) activity limitations and impairments in body functions were reported; and ⅲ) symptoms were not resolved with interventions.