EPIDEMIOLOGICAL STUDIES ON LOW BACK PAIN IN A SMALL RURAL COMMUNITY
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Since 1964, the author has investigated frequency, cause and medical treatment of low back pain in a rural village of Gunma prefecture. Further he observed, from sociological viewpoint, influence of low back pain on zeal of rural workers for production, and made epibemiological study on it.<BR>The 1st report gives the preliminary approach to the question-collection of data from 1, 422 inhabitants of both sexes by enquete on frequency, mode of development, condition and cause of low back pain. The 2 nd report gives X-ray observations of 274 inhabitants of both sexes with low back pain and obstructions in their everyday lives in thrms of work day loss and medical treatments, which are used for the assessment of their disability. It was clarified by the preliminary approach given in the 1st report that a considerable large proportion, 23.5% mentioned "coldness" as the cause of low back pain, and that it developed in winter twice as often as in summer. In view of this local skin temperature was measured with a thermistor in order to seek relation between indivedual reactivity against exposure to coldness and incidence rate of low back pain. In addition, the subjects were exposed to artificial coldness to observe their reactions. These are the contents of the 5rd report. The results are summarized as follows : <BR>1. The frequency of low back pain tended to increase with aging in both sexes. Actually suffering cases (those who have developed low back pain in the past 1 year) account for 15.3% and those who have its history, 42.0%. It needs much precaution to determine the frequency, since low back pain is variable in its nature, its manifestation is subjective, and its definition is not yet established.<BR>2. To the question 'when does the pain develop', the greatest number, 32%, responded, 'Always', followed by 19, 8% of 'Before going to bed', 13.4% of 'While walking', and 12% 'Abruptly'.<BR>3. As for the subjective cause and evoking factor 'not clear' represents 26. 1%, 'agricultural work' 25.3%, 'coldness' 25.5%, and 'trauma' relatively low 17. 7%.<BR>4. Disability owing to low back pain generally occurred in higher frequency in advanced ages and in females. High grade disability however, occurred also in thirties in both sexes. <BR>5. X-ray observation revealed spondylosis deformans in 44. 8% and osteoporosis in 23. 7%. Discopathy such as herniation of nucleus pulposus was relatively infrequent, Bone abnormality was absent in 17.3% of males and 29.4% of females. The X-ray findings were not always in agreement with the symptoms.<BR>6. As for the duration of the pain, 'within I week' accounted for 1/3 for both males and females. Considerably large proportions, 45% of males and 35% of females, complained of the pain more than 30 days in total in a year.<BR>7. about 37% received medical treatment, and the remainder were either imperfectly treated or untreated.<BR>8. More females than males complained of coldness; especially remarkable are714%of female in thirties and forties and 51.0% in fifties, who complained of coldness. Low back pain occurred more frequently in those who complained of coldness without regard to sex.<BR>9. Experiment on exposure to coldness (examination for rise in skin temperature on exposure to artificial coldness). Restoration of skin temperature was slow in those with objective symptoms such as tender point, , back pain, myosclerosis and lasegue.<BR>10. In relatively younger subjects who were actually suffering low back pain, skin temperature (on the hip) was lower than in the normal by 0. 1°0. 4°C.<BR>In the village of the present survey, there were many with the socalled lumdago, which is. induced by overwork in agriculture or by coldness. In those of advanced age were observed also spondylosis deformans and osteoporosis which result from physiological aging accelerated by overwork which is postulated as the result of enlargement of occupational sphere.
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