Comprehensive Review of Epidemiology, Scope, and Impact of Spinal Pain

Persistent pain interfering with daily activities is common. Chronic pain has beendefined in many ways. Chronic pain syndrome is a separate entity from chronic pain.Chronic pain is defined as, “pain that persists 6 months after an injury and beyondthe usual course of an acute disease or a reasonable time for a comparable injury toheal, that is associated with chronic pathologic processes that cause continuous orintermittent pain for months or years, that may continue in the presence or absence ofdemonstrable pathologies; may not be amenable to routine pain control methods; andhealing may never occur.” In contrast, chronic pain syndrome has been defined as acomplex condition with physical, psychological, emotional, and social components.The prevalence of chronic pain in the adult population ranges from 2% to 40%, witha median point prevalence of 15%. Among chronic pain disorders, pain arising fromvarious structures of the spine constitutes the majority of the problems. The lifetimeprevalence of spinal pain has been reported as 54% to 80%. Studies of the prevalenceof low back pain and neck pain and its impact in general have shown 23% of patientsreporting Grade II to IV low back pain (high pain intensity with disability) versus 15%with neck pain. Further, age related prevalence of persistent pain appears to be muchmore common in the elderly associated with functional limitations and difficulty inperforming daily life activities. Chronic persistent low back and neck pain is seen in25% to 60% of patients, one-year or longer after the initial episode.Spinal pain is associated with significant economic, societal, and health impact.Estimates and patterns of productivity losses and direct health care expenditures amongindividuals with back and neck pain in the United States continue to escalate. Recentstudies have shown significant increases in the prevalence of various pain problemsincluding low back pain.Frequent use of opioids in managing chronic non-cancer pain has been a major issuefor health care in the United States placing a significant strain on the economy withthe majority of patients receiving opioids for chronic pain necessitating an increasedproduction of opioids, and escalating costs of opioid use, even with normal intake. Theadditional costs of misuse, abuse, and addiction are enormous. Comorbidities includingpsychological and physical conditions and numerous other risk factors are common inspinal pain and add significant complexities to the interventionalist’s clinical task.This section of the American Society of Interventional Pain Physicians (ASIPP)/EvidenceBased Medicine (EBM) guidelines evaluates the epidemiology, scope, and impact ofspinal pain and its relevance to health care interventions.Key words: Chronic pain, chronic spinal pain, chronic low back pain, chronic neckpain, chronic thoracic pain, prevalence, health care utilization, loss of productivity,interventional techniques, surgery, comorbid factors, socioeconomic effects, healthcare impact