Back pain--individual and genetic factors.
BACKGROUND
In research, back pain can be classified in several ways. This presentation will deal with 'self-reported back pain', which is a proxy measure of 'having back pain'. The terms 'individual factors' cover many aspects of human life. They also interact with external factors, such as work and environment. Back pain is prevalent at all ages, although the incidence (onset) probably is highest in the early teens. Causative and modifying factors may differ throughout life and it is not sure that the etiology of 'back pain' remains the same. If we are to prevent and treat back pain in an efficient way, it is essential that we understand the circumstances that bring it on or prevent it from getting better. The mode of action would depend on whether the responsibility lies mainly with the individual, for example through a change of life-style, or with others, for example by altering the work place.


METHODS
My presentation will consist of three elements, evidence obtained from: (1). systematic literature reviews, (2). epidemiologic studies, and (3). genetic epidemiologic studies. All the information presented is based on own work and pertains to children/adolescents and adults, mostly in relation to low back pain (LBP). The evidence will be reviewed in the light of 'the weight of evidence' on the topics of: genetics, sedentary life-style, type of work and imaging findings. Also factors relating to social class and physical/psychological robustness will be discussed.


RESULTS
There is evidence for a relatively strong genetic component to LBP, both in the young and in adults. Hard work is strongly linked to LBP and there is a moderate link with abnormal imaging findings (spinal pathology in the young and discal degeneration in both the young and the adults). In addition, a weak psychological and psychological constitution appears to be of interest, at least in the young. However, there is no evidence for a causal link between a sedentary life-style and LBP, neither in the young nor in the adults.


CONCLUSIONS
Some myths in the area of back pain are dispelled by the evidence in relation to personal and genetic factors and some new elements need considering. It is suggested that we should look for populations at risk, rather than looking for risk factors. Populations at risk would consist of people with a weak psychological and physiological constitution, who more easily than others may develop long lasting back pain as well as other


CONCLUSIONS
Early identification of high risk populations will allow for a selective primary and secondary preventive approach.
Leboeuf-Yde
Charlotte
C
The Medical Research Unit in Ringkjøbing County, Amtsraadhuset, Torvet, DK-6950 Ringkøbing, Denmark. fecy@ringamt.dk
D000293:Adolescent; D000328:Adult; D001416:Back Pain / Q000209:etiology* / Q000235:genetics; D002648:Child; D006801:Humans; D007206:Individuality; D008019:Life Style; D012307:Risk Factors