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Back pain is a common problem that impacts more than 619 million people globally and remains the leading cause of disability worldwide. In the next three decades, that number is expected to jump to 840 million people.

“I don’t think this fact is widely known, and it became worse during the pandemic with people staying home and not having access to appropriate care,” said Eric Hurwitz, professor and director of the Office of Public Health Studies (OPHS) at the Thompson School of Social Work & Public Health at the University of Hawaiʻi at Mānoa. Hurwitz is an epidemiologist who has studied back pain for 30 years.

Eric Hurwitz headshot
Eric Hurwitz

In addition to known risks for back pain, including smoking, obesity and occupational ergonomic factors, a recent study co-authored by Hurwitz found an association to depression. Those with back pain were more likely to report symptoms consistent with depression at subsequent follow-up, and those with depression were more likely to report subsequent back pain. The study surveyed more than 2,000 adults in the U.S. over a nine-year period.

“Similar to back and neck pain, depression is also a leading cause of disability worldwide,” noted Hurwitz.

In another study involving Hurwitz and colleagues, researchers used data from the U.S. National Health Interview Survey and found that cardiovascular conditions, hypertension, diabetes as well as poor mental health were associated with higher odds of spinal pain. The study also found links between spinal pain and cognitive impairment.

“The next steps in this research will be to figure out why these associations exist, if they have common causes that we can intervene on, and the effectiveness of these interventions,” said Hurwitz. “We need more studies that can help us better understand the causal relationships (if any) between these conditions.”

Chiropractic care, epidemiology

Hurwitz has led numerous studies on the effectiveness of spinal manipulation and other therapies for treating back pain and other conditions often seen by chiropractors throughout his career. In his research, he looks at what populations tend to be at higher or lower risk, what are the risk and protective factors, and what are the best ways to manage it.

His interest in back pain therapy stems from his time in chiropractic school where he earned his doctor of chiropractic from Los Angeles College of Chiropractic. He took the advice of his teachers to pursue epidemiology and earned his master’s and PhD from UCLA. Hurwitz joined the faculty at UH Mānoa in 2006 where he has served as graduate chair of the epidemiology program in OPHS since 2010.

Keeping back pain away

So how does one deal with common back issues? Hurwitz advises, “Try to keep moving, find exercises or physical activities that you enjoy doing so you’ll keep at it. The important thing is to stay active and maintain a healthy weight so your back isn’t unduly strained. It not only helps physically, but for your mental well-being too, and being sedentary increases the risk for all of these musculoskeletal and non-musculoskeletal ailments.”

Hurwitz suggests walking, swimming and bicycling, as well as activities that aim to improve mobility and range of motion like stretching exercises, yoga and Tai Chi.

“Most back pain isn’t serious but if it’s persistent, and it keeps you from moving or sleeping, or goes down the leg, then it’s time to seek advice from a health care provider,” he said.

Big picture in public health

Hurwitz believes public health plays an important role in addressing back pain issues, and improving coordination efforts on multiple levels is needed.

“Interventions that motivate people in pain (either mentally or physically or both) to move more might have wide-ranging benefits,” Hurwitz said. “But what can we do not just individually, but as a community, society, organizationally, legislatively to promote health and well-being for all of us?”

He added, “We might have the motivation but societal or other constraints may get in the way, such as lack of safe spaces to exercise, the inability to afford gym membership and time constraints due to working multiple jobs.”

—by Arlene Abiang

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