Is the occurrence of back pain in Germany decreasing? Two regional postal surveys a decade apart

Background: Back pain is often perceived as an epidemic disorder with an ever-increasing prevalence. The objective of this paper is to estimate and compare point and period prevalence rates of back pain from two highly comparable postal surveys, a decade apart within a single regional population in the north of Germany. Methods: In 1991/1992 and 2003 two systematic random samples of German residents of Lübeck aged 25-74 years were independently drawn from the municipal population registry. They received a short postal questionnaire with maximally two reminders. All data were directly standardised on the age, sex, and educational distribution of the merged samples. A sharp decrease in response rates from 81% in the early 1990s to 60% in 2003 required complex considerations of non-response bias. Results: Both the overall and gender-specific point and 1 year prevalence rates of back pain remained fairly stable as well as the rate of severe disabling back pain. The overall prevalence (adjusted for age, sex, and education) of 'back pain today' was 39.2% (1991/92) and 38.2% (2003), the 1 year prevalence was 75.3% (1991/92) and 73.8% (2003), and the prevalence of severe pain was 9.9% (1991/92) and 10.2% (2003). Conclusions: The data do not support the widespread public notion of a growing epidemic of back pain in Germany.