Low back pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population.1 Because these population shifts are more rapid in low-income and middle-income countries, where adequate resources to address the problem might not exist, the effects will probably be more extreme in these regions. Most low back pain is unrelated to specific identifiable spinal abnormalities, and our Viewpoint, the third paper in this Lancet Series,2,3 is a call for action on this global problem of low back pain.
Bibliographical noteFunding Information:
RB is chief investigator or associate investigator on multiple previous and current research grants from government research agencies from Australia (eg, NHMRC, ARC), and overseas (eg, ZonMW in the Netherlands and PCORI in the USA). Her research has also received funding from philanthropy (eg, Arthritis Australia) and government agencies (eg, NSW WorkCover). She has been funded by research fellowships from NHMRC since 2005. She has received travel expenses for speaking at conferences from the professional organisations hosting the conferences. She chaired the back pain expert group for the 2010 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study. She was appointed to the Australian Medical Services Advisory Committee in May 2016. She has published multiple papers on low back pain, some of which might be referenced in the series. LMC is chief investigator or associate investigator on multiple previous and current research grants from government research agencies FAPESP and CNPq from Brazil. She has published multiple papers on low back pain some of which may be referenced in the series. PC has been chief investigator or co-investigator on multiple previous research grants for musculoskeletal pain research from UK government agencies (including National Institute for Health Research and the Medical Research Council) and UK charitable organisations (Arthritis Research UK and the Wellcome Trust), but none from industry. His travel expenses have been covered by the organising professional organisations (including rheumatology, pain specialists, physical therapy, primary care) when he has been an invited speaker at conferences. He has received honoraria for reviewing grant proposals from government organisations in Canada, Norway and Sweden. PC's department has received payment for two reports to the UK Committee on Advertising Practice. He has published multiple papers on low back pain, some of which might be referenced in the series. BÖ is head of research at the division and is responsible for previous and ongoing research funded by government research agencies in Sweden. She has received travel expenses for speaking at conferences from the professional organisations hosting the conferences. She chaired the Scientific Council of Medicine and Health from 2013 to 2016 and has been a member from 2010 to 2012. MS receives most of his funding from the publishing company Wolters Kluwer for writing and editing an international newsletter on spine and back pain research (The BackLetter). He authors all the articles and shares editorial control with the executive editor (a researcher, academic spine surgeon, and Chairman, Department of Orthopaedics at Georgetown University Medical Center). Neither has any conflicts of interest with drug or device companies. MS has co-authored several editorials for journals owned by publishers (The Spine Journal and Spine—owned respectively by Elsevier and Wolters Kluwer). The editorials concerned the inadequacy of the evidence base for regulated surgical devices or drugs and biologics. He received nothing of value for those editorials. The remainder of his funding comes from the non-profit Sports Health and Safety Institute at the University of Washington for research, writing, and editing in the concussion area. He was previously a paid consultant for the non-profit Informed Medical Decisions Foundation in Boston, involved in the preparation of Decision Aids and Shared Decision Making materials. He occasionally receives travel funding from professional societies to take part in symposia sponsored by those societies. MS has been an unpaid editorial board member and Consumer Representative at the Cochrane Collaboration Back and Neck Group since 1999. MvT is chief investigator, or co-investigator on multiple previous and current research grants from government research agencies in the Netherlands (ZONMW; the Dutch Health Insurance Council) and Australia (NMHRC). His research has also received funding from professional organisations (eg, the Royal Dutch Association for Physiotherapy, the Netherlands National Chiropractic Association, and the European Chiropractic Union). His travel expenses have been covered by the organizing professional organizations when he has been an invited speaker at conferences. He has received honoraria for reviewing grant proposals from the Swedish Medical Research Council and VINNOVA (Sweden's innovation agency). He has not received any honoraria or travel expenses from the industry. MvT was chairman of the Netherlands National Multidisciplinary Guideline on Low Back Pain. He has published multiple papers on low back pain, some of which might be referenced in the series. AW has been chief investigator or co-investigator on projects to identify burden of musculoskeletal conditions and to develop strategies for their control. He has been an expert adviser to WHO. He is chair of the Global Alliance for Musculoskeletal Health. The European Community, professional bodies, and research agencies have supported his work. Professional bodies or organisers of scientific meetings have supported his travel expenses. He has not received any funding from the private sector.
Funding for low back pain research is inadequate and uncoordinated. This scarcity of funds especially affects low-income and middle-income countries, where the effects of disabling low back pain remain under-recognised and research priorities and funding remain focused on infectious diseases. One way forward would be to establish a global network of researchers from developed and developing countries, pooling experience and knowledge and building research capacity where it is needed.
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