Neck Pain and Low Back Pain in Medical Students: A Cross-Sectional Study

Abstract

Background: Neck Pain (NP) and Low Back Pain (LBP) are among the top four major causes of disability. There is a paucity of data regarding the prevalence and Quality of Life (QOL) issues associated with NP and LBP in American medical students. The aim of the present study was to characterize NP and LBP in American medical students. Methods: A cross-sectional print-based survey was conducted from May to September 2013 among medical students (MS1, MS2, MS3, MS4 and new MS0 classes) enrolled at a Liaison Committee on Medical Education-accredited medical school (Weill Cornell Medical College). Pain severity and QOL issues were assessed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Perceived stress was assessed using the Perceived Stress Scale (PSS)-10. Main outcome measures were the prevalence and severity of self-reported NP and LBP and association with QOL issues, lifestyle and stress. Statistical analysis was performed using one way Analysis of Variance or two-tailed student’s t-tests as appropriate. Results: Survey completion rate was 96% (210 of 221 surveys administered out of 506 total enrolled students). Mean age of study participants was 24.7 ± 4.3 years (range: 20- 53 years). Overall prevalence of NP and LBP were 35% (74/210) and 47% (99/210), respectively. A total of 66 medical students reported both NP and LBP (31%). Of students with NP and LBP, the average VAS scores were 2.6 ± 1.8 out of 10 and 3.2 ± 1.6 out of 10 respectively. There were 26 students (12%) who reported moderate to severe NP (VAS ≥ 3), 62 students (30%) who reported moderate to severe LBP (VAS ≥ 3) and 36 students (17%) who reported moderate to severe effect QOL issues (ODI ≥ 9). The most common QOL issues were headaches (n = 83) for NP and pain exacerbated during standing (n = 60) for LBP. Increased sleep (r = - 0.138, p = 0.045) and decreased stress (r = 0.145, p = 0.035) correlated with decreased ODI. Compared to students with none or mild back pain and QOL issues, students with moderate to severe back pain (12.98 ± 14.93 vs. 22.92 ± 17.50 hours/ week, p < 0.001) and QOL issues (13.54 ± 15.58 vs. 21.21 ± 17.43 hours/week, p = 0.02) spent less time studying. Onset of pain began during medical school for 23 students and before medical school for 84 students. There were no significant differences in VAS neck, VAS back, or ODI across MS1 through MS4 classes (p = 0.485, p = 0.523, p = 0.264, respectively) or between MS0 vs. MS1-4 classes (p = 0.865, p = 0.828, p = 0.944, respectively). Conclusions: There was a high prevalence of mild NP and LBP in medical students at a LCME-accredited U.S. medical school. Headache and pain exacerbated by standing were common QOL issues. Increased musculoskeletal pain may impact academic performance. Onset of pain commonly occurred before medical school.