Increased risk of strokes in patients with chronic low back pain (CLBP): A nationwide population-based cohort study

Objectives: There have not been any longitudinal studies reported that chronic low back pain (CLBP) patients are at risk for stroke. Thus, in this study, we explored the association between CLBP and strokes. Patients and methods: Data (2000 similar to 2010) from the Taiwan National Health Insurance database were analyzed. We matched 10,308 CLBP patients with 20,616 propensity score-matched non-low back pain (NLBP) patients according to age, gender, index year and comorbidities. Covariates of age, gender, comorbidities, and usage of non-steroidal anti-inflammatory drugs (NSAIDs) were adjusted and analyzed. Results: The mean follow-up duration was 8 years. CLBP patients had higher risks of all stroke, hemorrhagic stroke, and ischemic stroke. The adjusted hazard ratios (aHRs) were 2.35 (95 % confidence interval (CI): 2.14-2.57, p< 0.001), 1.55 (95 % CI: 1.16-2.06, p = 0.003), and 2.41 (95 % CI: 2.18-2.66, p< 0.001), respectively. After adjusting and analyzing the NSAIDs used for the varied duration in the CLBP patients, we did not observe any impacts of such NSAIDs used on the association of CLBP with strokes. The association between CLBP and ischemic stroke was most prominent in the patients less than 50 years old with aHR: 3.56 (CI: 2.74 similar to 4.61, p< 0.001). Conclusion: CLBP was associated with increased risk of strokes, especially ischemic stroke, and the association was most prominent in patients less than 50 years old. Further large prospective studies on detailed lifestylerelated factors and qualitative pain assessment are needed to clarify the causal relationship between CLBP and stroke.