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Formal education and back pain: a review
  1. C E Dionnea,
  2. M Von Korffb,
  3. T D Koepsella,
  4. R A Deyoc,
  5. W E Barlowb,
  6. H Checkowaya
  1. aDepartment of Epidemiology, University of Washington, Seattle, USA, bCenter for Health Studies, Group Health Cooperative of Puget Sound, Seattle, USA, cCenter for Cost and Outcomes Research, Back Pain Outcome Assessment Team, University of Washington, Seattle, USA
  1. Dr Dionne, Groupe de recherche en épidémiologie, Centre de recherche du Centre hospitalier affilié universitaire (CHA) de Québec, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, Québec, Canada G1S 4L8 (clermont.dionne{at}


OBJECTIVES To summarise the scientific evidence on the relation between educational status and measures of the frequency and the consequences of back pain and of the outcomes of interventions among back pain patients, and to outline possible mechanisms that could explain such an association if found.

DESIGN Sixty four articles published between 1966 and 2000 that documented the association of formal education with back pain were reviewed.

MAIN RESULTS Overall, the current available evidence points indirectly to a stronger association of low education with longer duration and/or higher recurrence of back pain than to an association with onset. The many reports of an association of low education with adverse consequences of back pain also suggest that the course of a back pain episode is less favourable among persons with low educational attainment. Mechanisms that could explain these associations include variations in behavioural and environmental risk factors by educational status, differences in occupational factors, compromised “health stock” among people with low education, differences in access to and utilisation of health services, and adaptation to stress. Although lower education was not associated with the outcomes of interventions in major studies, it is difficult, in light of the current limited available evidence, to draw firm conclusions on this association.

CONCLUSION Scientific evidence supports the hypothesis that less well educated people are more likely to be affected by disabling back pain. Further study of this association may help advance our understanding of back pain as well as understanding of the relation between socioeconomic status and disease as a general phenomenon.

  • back pain
  • educational status

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  • Funding: this work was supported in part by the National Health Research and Development Program of Canada (NHRDP) and the Quebec Health Research Funds (FRSQ) through scholarships to CE Dionne.

  • Conflicts of interest: none.