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. 2025 May 5;17(5):e83518.
doi: 10.7759/cureus.83518. eCollection 2025 May.

Evaluation of the Prevalence, Trends, and Correlates of Low Back Pain in India: A Retrospective Cross-Sectional Study

Sunil H Shetty  1 , Amarnath S S  2 , Arnab Karmakar  3 , Monjori Mitra  4 , Nishikant Madkholkar  5 , Roshan Pawar  5 , Akhilesh Sharma  5
Affiliations

Evaluation of the Prevalence, Trends, and Correlates of Low Back Pain in India: A Retrospective Cross-Sectional Study

Sunil H Shetty et al. Cureus. .

Abstract

Background: Low back pain (LBP) is a leading cause of disability worldwide, including a significant portion of the Indian population; however, comprehensive epidemiological data are lacking. This study aimed to explore the prevalence, risk factors, and prescribing patterns for LBP in the Indian population.

Methods: This cross-sectional, retrospective study (CTRI/2025/01/079359 (registered on: January 24, 2025)) analyzed anonymized electronic medical record (EMR) data of 16866 patients from 76 private centers in 18 states across India, diagnosed with LBP between 2019 and 2023. The primary outcomes include the assessment of the prevalence of LBP across demographic and clinical subgroups, the distribution of treatment practices among various medical specialties, and the utilization of medication classes such as nonsteroidal anti-inflammatory drugs (NSAIDs) and calcium supplements. Secondary outcomes include the assessment of the prevalence of LBP categorized by sex, BMI, age group, and comorbidities, as well as the proportion of patients with LBP treated by physicians of different medical specialties. Anthropometric parameters, including weight, height, and body mass index (BMI), were assessed. The prevalence of LBP, associated symptoms, comorbidities, and prescribing trends were examined using statistical analyses.

Results: Among 16866 patients diagnosed with LBP, the prevalence of LBP fluctuated across the five-year study period (2019-2023). From 3767 cases (22.33%) in 2019, prevalence declined sharply to 2762 cases (16.38%) in 2020 (χ² = 154.7, p < 0.001), followed by a significant increase to 3272 cases (19.40%) in 2021 (χ² = 43.11, p < 0.001 compared to 2020). Prevalence remained statistically stable in 2022 at 3248 cases (19.26%; χ² = 0.09, p = 0.766 compared to 2021), before rising significantly to 3817 cases (22.63%) in 2023 (χ² = 45.83, p < 0.001 compared to 2022). Notably, while the 2023 prevalence represented the highest point in the study period, it was not statistically different from the 2019 baseline (χ² = 0.33, p = 0.566). Females exhibited a significantly higher prevalence of LBP compared to males (11420 (67.71%) vs. 5546 (32.29%), p < 0.001). Additionally, 10328 (61.24%) patients were classified as overweight or obese. Among patients with comorbidities, 3870 (22.95%) patients presented with gastrointestinal disorders, 2763 (16.38%) had orthopedic conditions, and 2226 (13.20%) were diagnosed with hypertension. These conditions were identified as significant predictors of LBP. Calcium supplements were utilized by 4479 (26.56%) patients, NSAIDs by 4350 (25.79%), and NSAID-muscle relaxant combinations by 1342 (7.96%) patients, with a limited use of opioids in 633 (3.75%) patients.

Conclusion: This pan-Indian cross-sectional study highlighted LBP as a major health burden affecting anthropometric parameters. Key risk factors included female gender, young adulthood, and high BMI, emphasizing the need for targeted management strategies.

Keywords: adults aged 18 and older; body mass index (bmi); calcium therapy; comorbidity profiles; non-steroidal anti-inflammatory drugs (nsaids); real-world evidence.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Royal Pune Independent Ethics Committee issued approval RPIEC081124. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Dr. Nishikant Madkholkar, Dr. Roshan Pawar, and Dr. Akhilesh Sharma declare(s) employment from Alkem Laboratories Private Limited. The mentioned authors are full-time employees of Alkem Laboratories Private Limited, Mumbai, India. Other authors have no competing interests to declare. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. STROBE diagram showing selection of patients diagnosed with low back pain
STROBE: Strengthening the Reporting of Observational studies in Epidemiology
Figure 2
Figure 2. Distribution of BMI categories in each age group
Figure 3
Figure 3. (A) Overall prevalence and (B) age group-wise prevalence of LBP over five years from 2019 to 2023
LBP: low back pain
Figure 4
Figure 4. Specialty-wise patient visits presented to the healthcare physicians
The total number of subjects (N) = 16866
Figure 5
Figure 5. Prescription pattern and medication utilization distribution among LBP patients over five years (2019-2023)
LBP: low back pain; NSAID: nonsteroidal anti-inflammatory drug
See this image and copyright information in PMC

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