Increased risk of strokes in patients with chronic low back pain (CLBP): A nationwide population-based cohort study
Hao-Chin Wang1, Yuan-Chih Su2, Hsiang-Ning Luk1
1Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
Insights
Chronic low back pain (CLBP) patients face a significantly higher risk of stroke, particularly ischemic stroke. This association, observed over an 8-year follow-up, was most pronounced in individuals under 50 years old.
Area of Science:
- Neurology
- Epidemiology
- Pain Medicine
Background:
- Longitudinal studies investigating the link between chronic low back pain (CLBP) and stroke risk are lacking.
- Understanding potential risk factors for stroke is crucial for public health initiatives.
Purpose of the Study:
- To investigate the association between chronic low back pain (CLBP) and the risk of experiencing a stroke.
- To determine if CLBP is an independent risk factor for various types of stroke.
Main Methods:
- A retrospective cohort study utilizing data from Taiwan's National Health Insurance database (2000-2010).
- 10,308 CLBP patients were propensity score-matched with 20,616 non-low back pain (NLBP) controls.
- Adjustments were made for age, gender, comorbidities, and non-steroidal anti-inflammatory drug (NSAID) usage.
Main Results:
- CLBP patients exhibited significantly higher risks for all stroke types, including hemorrhagic and ischemic stroke (aHRs ranging from 1.55 to 2.41).
- The association between CLBP and ischemic stroke was particularly strong in patients under 50 years old (aHR: 3.56).
- NSAID usage did not appear to influence the observed association between CLBP and stroke risk.
Conclusions:
- Chronic low back pain is associated with an elevated risk of stroke, especially ischemic stroke.
- The heightened risk is most prominent in younger adults (under 50) with CLBP.
- Further research, including prospective studies, is needed to elucidate the causal mechanisms linking CLBP and stroke.
Objectives:
There have not been any longitudinal studies reported that chronic low back pain (CLBP) patients are at risk for stroke. Thus, in this study, we explored the association between CLBP and strokes.
Patients And Methods:
Data (2000∼2010) from the Taiwan National Health Insurance database were analyzed. We matched 10,308 CLBP patients with 20,616 propensity score-matched non-low back pain (NLBP) patients according to age, gender, index year and comorbidities. Covariates of age, gender, comorbidities, and usage of non-steroidal anti-inflammatory drugs (NSAIDs) were adjusted and analyzed.
Results:
The mean follow-up duration was 8 years. CLBP patients had higher risks of all stroke, hemorrhagic stroke, and ischemic stroke. The adjusted hazard ratios (aHRs) were 2.35 (95 % confidence interval (CI): 2.14-2.57, p < 0.001), 1.55 (95 % CI: 1.16-2.06, p = 0.003), and 2.41 (95 % CI: 2.18-2.66, p < 0.001), respectively. After adjusting and analyzing the NSAIDs used for the varied duration in the CLBP patients, we did not observe any impacts of such NSAIDs used on the association of CLBP with strokes. The association between CLBP and ischemic stroke was most prominent in the patients less than 50 years old with aHR: 3.56 (CI: 2.74∼4.61, p < 0.001).
Conclusion:
CLBP was associated with increased risk of strokes, especially ischemic stroke, and the association was most prominent in patients less than 50 years old. Further large prospective studies on detailed lifestyle-related factors and qualitative pain assessment are needed to clarify the causal relationship between CLBP and stroke.
Related Concept Videos
01:23Atherosclerosis IV: Nursing Management
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...