This study was entirely patient-reported, and no confirmation of diagnosis, treatment usage, or health care resource utilization was available. This study also focused exclusively on LBP only, and relevant subgroups (such as chronic LBP) could not be examined due to lack of sufficient sample size. The NHWS is cross-sectional, and therefore a causal relationship between pain severity and health outcomes cannot be established. Related to this point, we identified as many confounding variables as possible, but other variables not assessed may have contributed. The cross-sectional nature of the survey also prevented us from fully exploring potential mediating relationships. For example, it is possible that LBP could have contributed to a lack of exercise and an increased BMI (among other things), which in turn could have affected health outcomes. By controlling for these factors (as we did), we may have underestimated the effect of LBP since we ignored these indirect pathways. This should be further explored in future studies. Our analytical approach also assumed independence between LBP and matched controls; the significance testing would have been affected (ie, more liberal) had we chosen to assume these groups were dependent.
It also should be noted that there are many dimensions to the experience of pain (eg, frequency and intensity). We asked patients directly to report their severity, but it was unclear which specific dimensions of pain led to their responses. As a final limitation, the NHWS is broadly representative of the adult Japanese population with respect to key demographic characteristics; however, there may be other differences (eg, comorbidity profile, health care attitudes, etc) that may limit the generalizability of the findings. For example, those without Internet access and disenfranchised groups would be underrepresented.
This study was entirely patient-reported, and no confirmation of diagnosis, treatment usage, or health care resource utilization was available. This study also focused exclusively on LBP only, and relevant subgroups (such as chronic LBP) could not be examined due to lack of sufficient sample size. The NHWS is cross-sectional, and therefore a causal relationship between pain severity and health outcomes cannot be established. Related to this point, we identified as many confounding variables as possible, but other variables not assessed may have contributed. The cross-sectional nature of the survey also prevented us from fully exploring potential mediating relationships. For example, it is possible that LBP could have contributed to a lack of exercise and an increased BMI (among other things), which in turn could have affected health outcomes. By controlling for these factors (as we did), we may have underestimated the effect of LBP since we ignored these indirect pathways. This should be further explored in future studies. Our analytical approach also assumed independence between LBP and matched controls; the significance testing would have been affected (ie, more liberal) had we chosen to assume these groups were dependent.It also should be noted that there are many dimensions to the experience of pain (eg, frequency and intensity). We asked patients directly to report their severity, but it was unclear which specific dimensions of pain led to their responses. As a final limitation, the NHWS is broadly representative of the adult Japanese population with respect to key demographic characteristics; however, there may be other differences (eg, comorbidity profile, health care attitudes, etc) that may limit the generalizability of the findings. For example, those without Internet access and disenfranchised groups would be underrepresented.
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