NURSES have long been seen as vulnerable to developing back pain. In fact, in 1995 the prevalence in nurses of back pain was 14.7% compared with 11.5% in age-matched controls, according to the study Epidemiological aspects of back pain1.  An obvious cause for this difference would be due to the demands of lifting and handling, as was felt by the participants.

The study also shows that back pain is common even if you are not a nurse. University of Oxford research has shown that in some people with early onset chronic back pain, especially those younger than 50, there are links with earlier than average disc degeneration in the lower lumbar spine that are more prevalent than asymptomatic age matched controls.  In others there are no identifiable pathological changes on MRI scans. Most of these degenerative changes occur at the lower two mobile levels of the lumbar spine.  This study, submitted for publication, was confined to female subjects, though there is no reason to believe that males are more or less afflicted than females.

Anxiety and depression exacerbate chronic pain

So what are the factors that contribute to this common complaint?  We know that overweight and poor physical fitness are important contributors to back pain. Anxiety and depression have long been recognized as conditions that exacerbate chronic pain.  There is increasing evidence to suggest that inflammation is an important process underlying chronic pain.  We need large scale studies to explore these relationships which have so far not been funded.

Over the last 25 years, there have been many improvements in lifting and handling techniques and practices.  BackCare publishes a regularly updated evidence-based training guide to lifting and handling, currently the edition is HOP6, with a new HOP7 on the way, which has specific advice for nurses and their training.  There are many aids for lifting and handling patients.  They range from simple devices to facilitating sliding patients during transfers, to sophisticated devices for recovering fallen patients, such as the HoverJack Device (  These have transformed nursing practice.  Fortunately, most people, including nurses, have back pain that can be controlled with simple measures available in primary care, including basic analgesics, fitness, weight control and manual therapy.  We still have more work to do to develop effective and evidence-based therapies for chronic back pain.

Jeremy Fairbank MD FRCS, Emeritus

Professor of Spine Surgery, University of Oxford

1 Leighton D, Reilly T. Epidemiological aspects of back pain: the incidence and prevalence of back pain in nurses compared to the general population. Occupational Medicine,1995;45(5):263–7.

Article from TalkBack, Autumn | 2020 (BackCare)

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