Back and neck pain: Patterns in healthcare consultations

University dissertation from Department of Orthopaedics, Lund University

Abstract: Musculoskeletal disorders are very common and affects the individual by pain and functional impairment, and the society
through work disability and healthcare utilisation. To what extent is less studied. Routinely collected healthcare
registers is a potential resource for epidemiological studies of musculoskeletal disorders. Skåne region, as opposed to
nationally in Sweden, has healthcare registers, covering all care including primary care.
he overall aim of this thesis was to incorporate healthcare registers in the epidemiological research of consultation
prevalence, healthcare consultation and sick leave patterns in patients with musculoskeletal disorders.
he thesis comprises four studies in which the Skåne Healthcare Register was linked with national registers on sick
leave, prescribed drugs, and socioeconomic status. Additionally, the thesis include a comparative study between data
from the Skåne Healthcare Register with that of an United Kingdom (UK) consultation database. he main variables
under study are in Paper I–III disease, consultations, and sick leave and in Paper IV education, income, and work status.
he consultation prevalence of low back pain was estimated to 3–4% in the Skåne region while the figure was larger
in the UK. People having low back pain had increased levels of healthcare consultations in general, and more pain diagnoses
in particular. People diagnosed with whiplash associated neck injury had higher healthcare consultation rates
already three years before the neck injury and the postinjury consultation level was associated with the preinjury consultation
levels. Low socioeconomic status was associated with being diagnosed with chronic pain.
It was feasible to use routinely collected databases in the studies of the burden of disease from musculoskeletal disorders,
thus potentially also for other public health disorders. While there are vast potentials with register data, it is also
important to bear in mind limitations due to e.g., missing data and misclassification which may introduce bias. My
main findings indicate a need for early interventions after initial pain and neck injury to prevent the pain to becoming
chronic. Stratification-based management is especially suggested.