The association of different types of stress, and stress accumulation with low back pain in call-center workers - a cross-sectional observational study.

Background: Low back pain (LBP) is a common health complaint and a prominent factor in the development of LBP among the working population is stress. Mostly, stress is addressed as a general problem, which is why LBP prevention programs are often imprecise. Accordingly, a closer look at the association between specific stress types and the development of LBP is necessary. Therefore, this paper aims (1) to identify the stress types most closely associated with LBP; (2) to examine the relationship between stress accumulation and LBP.

Methods: n = 100 call-center workers were approached for participation. Stress levels and LBP were assessed with questionnaires (TICS, ERI, CPG, BPI) and hair cortisol levels were measured (ELISA-KIT, 3-months period). Mann-Whitney U tests were used to identify stress types most closely associated with LBP. Further, ANCOVA analysis was conducted to determine the association of the number of experienced stress types with LBP intensity and impairment.

Results: Finally, data from n = 68 participants (mean age: 43.2 (± 12.8) years; 62% female) were used for presented analysis. Participants, who were affected by work-related stress showed higher pain severity (excessive demands at work: 23.6 ± 21.8 vs. 42.4 ± 25.0 (p = 0.005)) and more impairment (excessive demands at work: 13.7 ± 17.6 vs. 28.7 ± 22.3 (p = 0.003); work overload: 15.4 ± 20.4 vs. 26.3 ± 17.4 (p = 0.009)) than their less affected colleagues. Other stress types (e.g. Effort, Reward) showed no significant association with LBP. Furthermore, participants who experienced two or more of the most associated stress types simultaneously suffered from stronger pain and more impairment (p < 0.01).

Conclusions: The results suggest that it is essential to divide and evaluate stress in specific domains. Furthermore, the accumulation of different stress types and the resulting physiological load should be taken into account when designing prevention and intervention programs. Results may be of high relevance for the development of LBP prevention programs for people within a predominantly sitting working context.