Multimorbidity is prevalent among patients with low back pain

According to research, a significant part of the people who live with chronic musculoskeletal problems also live with multimorbidity. Danish researchers have studied the incidence of multimorbidity among chiropractic patients with low back pain. In addition, they looked at whether the presence of multiple chronic conditions affects pain intensity, self-rated health, mental and physical health, and whether patients with multimorbidity experience a different improvement in their low back pain than patients who do not suffer from multimorbidity.

Patients with multimorbidity face more challenges than others

It is estimated that between 13% and 95% of all patients aged 18 - 65 years and older who see a chiropractor because of low back pain suffer from multimorbidity, and the number is expected to grow as the number of elderly people increases in the population.

The study shows that approximately 20% of patients with chronic low back pain in the study cohort suffer from multimorbidity. Patients with multimorbidity reported higher pain levels, poorer self-rated health, and poorer physical function compared to those without multimorbidity.

Both groups of patients experienced an improvement in their low back pain over time, but patients with high pain levels and multimorbidity at baseline experienced less improvement in their back-related functional difficulties than patients without chronic diseases.

Furthermore, patients with multimorbidity continued to use pain medication for low back pain, unlike patients without chronic disease.

According to the researchers behind the study, chiropractors should be aware that patients with high levels of low back pain and multimorbidity have a lower recovery rate than patients without chronic disease, and follow-up treatment may be needed.

Furthermore, the challenge for chiropractors is to avoid seeing low back pain as an isolated pain condition, rather it must be seen as one of several diseases in cases of multimorbidity.

What is multimorbidity?

In contrast to comorbidity, which is the occurrence of two mutually independent disorders at the same time in the same person, multimorbidity is the coexistence of two or more chronic conditions in a patient.

Chronic musculoskeletal conditions include osteoarthritis, rheumatoid arthritis, osteoporosis, low back pain, neck pain and fibromyalgia.

Multimorbidity often means pain and functional limitations caused by musculoskeletal disorders in combination with other chronic disorders.

Musculoskeletal pain is present in patients with multimorbidity due to their high prevalence, shared risk factors and the pathogenic processes they share with other long-term conditions.

The pain is often associated with reduced ability to work and a lower quality of life.

Read more in the research paper

The study is based on data from ChiCo (The Danish Chiropractic Low Back Pain Cohort). All participants are at least 18 years old and suffer from a recent case of low back pain without leg pain. The study is described in a research paper in Chiropractic & Manual Therapies.

Rafn, B.S., Hartvigsen, J., Siersma, V. et al. Multimorbidity in patients with low back pain in Danish chiropractic practice: a cohort study. Chiropr Man Therap 31, 8 (2023). https://doi.org/10.1186/s12998-023-00475-3