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Eur J Pain. 2007 May;11(4):387-97. Epub 2006 Jun 21.

Comorbidity of low back pain: representative outcomes of a national health study in the Federal Republic of Germany.

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Stiftung Orthopädische Universitätsklinik Heidelberg, Forschungsgruppe Epidemiologie und Biometrie, Schlierbacher Landstrasse 200, D-69118 Heidelberg, Germany.



Unlike other biopsychosocial risk factors, the role of comorbidity in low back pain is largely unknown.


The purpose is (1) to generate prevalence data on back pain in the total adult population and (2) to identify the most common physical comorbidities in subjects with back pain. This paper also (3) analyses the gender-specific and age-specific comorbidity structure.


The National German Health Survey is the first study to provide the basis for a representative nationwide analysis of back pain prevalence and the associated comorbidities. The net sample comprises a total of 7124 Germans aged 18-79.


One in three Germans (34%) experienced back pain during the seven days prior to being interviewed. The one-year prevalence rate is 59%. All the morbidities investigated by us are more common in subjects with back pain than in individuals without back pain. The most common comorbidities associated with back pain are musculoskeletal disorders like rheumatoid arthritis, osteoarthritis and osteoporosis, followed by cardiovascular and cerebrovascular disease.


The present study investigating 31 physical diseases is the most extensive analysis to date on the topic of back pain and comorbidity. This is an attempt to cast light on the tangled relationships involved in developing and coping with back pain. In view of the large percentage of unspecific back pain, we believe it is important for physicians treating back pain to extend their history and diagnostic analysis skills to embrace comorbidities related to the back pain.

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