title: Is alcohol intake associated with low back pain? A systematic review of observational studies.
abstract: BACKGROUND
  Alcohol intake has been widely reported as a risk factor for low back pain (LBP), however, the literature is inconclusive about this association.
  
  
  OBJECTIVE
  To determine, in a systematic review, the relationship between alcohol intake and LBP.
  
  
  METHODS
  A search was conducted in CINAHL, LILACS, Medline, National Research Register and Web of Science to identify studies that investigated the association between alcohol intake and LBP. Quantitative results and its estimators were extracted. When possible, meta-analyses were performed using a random effects model.
  
  
  RESULTS
  Twenty-six studies were included in this review. Twenty-three studies were retrospective cohorts, two were case-controls, and one employed a longitudinal design. Pooled results from nine studies (two case-controls and seven retrospective cohorts) showed that alcohol consumption is slightly associated with LBP (OR: 1.3; 95% CI: 1.1-1.5). This association appears to be present in studies investigating alcohol as an abuse dependence substance in chronic LBP. Remaining individual studies tended to report no statistical significant association. No dose-response relationship was identified. Only one longitudinal study was identified and even though alcohol consumption was found to be negatively associated with a future episode of LBP (OR: 0.7; 95% CI: 0.5-0.9) this association lost significance for future incidence of LBP in people with no LBP at baseline.
  
  
  CONCLUSIONS
  Alcohol consumption appears to be associated with complex and chronic LBP only and in people with alcohol consumption dependence. Clinicians in the musculoskeletal field could use this information to design educational strategies for this population.
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, PO Box 170, Lidcombe, Sydney, NSW 1825, Australia. paulo.ferreira@sydney.edu.au
authors.forename: Paulo Henrique
authors.initials: PH
authors.lastname: Ferreira
authors.forename: Marina Barros
authors.initials: MB
authors.lastname: Pinheiro
authors.forename: Gustavo Carvalho
authors.initials: GC
authors.lastname: Machado
authors.forename: Manuela Loureiro
authors.initials: ML
authors.lastname: Ferreira
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D006801:Humans; D017116:Low Back Pain / Q000209:etiology*; D012307:Risk Factors