Multimorbidity in Patients with Low Back Pain in Danish Chiropractic Practice: A Cohort Study

Low back pain (LBP) can be associated with comorbidity, but it is unknown to what extent LBP is accompanied by chronic diseases and contributes to multimorbidity among patients seeking help from a chiropractor, and to what extent chiropractors treat patients with multimorbidity and how this affects the patients and the clinical course of back pain.

This is the first study to investigate the prevalence of multimorbidity among patients with LBP in chiropractic practice and whether multimorbidity affects pain intensity, self-reported health, physical and mental health, and whether people with multimorbidity and LBP have a different course than people who only have LBP¹.

Patients were recruited from 2016–2018 from 10 chiropractic clinics that were part of the ChiCo cohort². A total of 2083 patients were included in the analyses, of which 20% had multimorbidity (≥ 2 chronic diseases). The most common chronic diseases were hypertension, osteoarthritis, and migraine. The presence of multimorbidity was associated with increased odds of poor self-reported health, poor physical condition, poor muscle strength, poor endurance, and poor balance. Multimorbidity was not associated with depression or anxiety. All participants improved over time, regardless of baseline pain intensity and the presence of multimorbidity, and fewer used pain medication. Patients with high LBP intensity combined with multimorbidity fared worse than patients without chronic diseases. Additionally, patients with multimorbidity used more pain medication for LBP at 12-month follow-up compared to those without chronic disease.

Chiropractors should be aware that patients with LBP may suffer from multimorbidity and consequently poor general health. Furthermore, LBP may not be considered a regional pain condition but a manifestation of poor health that for many includes other pain conditions and diseases. This should be an important focus for chiropractors and other healthcare professionals managing this patient group. These patients will likely benefit from a broad approach consisting of manual treatment, patient education, exercise, and encouragement to be physically active in general.

1. Rafn, B. S., et al. (2023). "Multimorbidity in patients with low back pain in Danish chiropractic practice: a cohort study." Chiropr Man Ther 31(1): 8.
2. Kongsted A, Nielsen OL, Christensen HW, Hartvigsen J, Doktor K, Kent P, et al. The Danish chiropractic low back pain cohort (ChiCo): description and summary of an available data source for research collaborations. Clin Epidemiol. 2020;12:1015–27.