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Approved Research

Socioeconomic determinants of spine health

Principal Investigator: Dr John Martin
Approved Research ID: 96839
Approval date: April 5th 2023

Lay summary

Scientific rationale

Our bodies were originally wired to respond to stress by amplifying our awareness and physical abilities to evade predators. The same stress response still exists in us today. While we likely are not escaping lions, we still have stressful experiences due to many external pressures at home, at school, in the workplace, in social settings, etc. For some, these stressors can be overwhelming, and their body is long-term in a state of increased activity, or chronic stress. This gets 'under your skin'. Chronic stress can cause many diseases like chronic pain, heart disease, kidney disease, neurological diseases like Alzheimer's, and even cancer. Social and economic obstacles can prevent you from living a happy and healthy life, including acquiring a good job or an education, providing for yourself or your family, and from accessing healthy food or affordable health care. This leads to stress and, as a result, socioeconomic status is associated with many of the same chronic diseases as chronic stress.

Low back pain is the world's leading cause of disability, and like the diseases above, low back pain is associated with both chronic stress and low socioeconomic status. Unfortunately, doctors cannot tell their patients what is causing their back pain 90% of the time. Desperate for a solution, back pain patients are prescribed physical therapy, pain killers and spinal injections, spine x-rays and MRIs, and sometimes even spine surgery. The unfortunate truth is that most individuals do not overcome their chronic back pain. So, perhaps low back pain requires a different treatment approach? For a back pain patient with a stressful living situation, a pill may temporarily relieve their pain, but the stress of their living situation will still be there.

Public health impact

Our goal is to convince doctors and spine researchers that treating low back pain requires considering an individual's socioeconomic wellbeing as well as their physical health. In this project, we will determine how living in a stressful environment affects your spine. We will examine the spines of thousands of individuals across the UK and determine how their living conditions affect the physical appearance of the spine.


The first Aim is to develop computer vision software to assess spine health in in x-ray images. The second Aim is to determine the relationships between low back pain, socioeconomic status, chronic stress, and spine health. We expect this project to be completed in three years.