Persistent pain interfering with daily activities is common. Chronic pain has been
defined 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 beyond
the usual course of an acute disease or a reasonable time for a comparable injury to
heal, that is associated with chronic pathologic processes that cause continuous or
intermittent pain for months or years, that may continue in the presence or absence of
demonstrable pathologies; may not be amenable to routine pain control methods; and
healing may never occur.” In contrast, chronic pain syndrome has been defined as a
complex condition with physical, psychological, emotional, and social components.
The prevalence of chronic pain in the adult population ranges from 2% to 40%, with
a median point prevalence of 15%. Among chronic pain disorders, pain arising from
various structures of the spine constitutes the majority of the problems. The lifetime
prevalence of spinal pain has been reported as 54% to 80%. Studies of the prevalence
of low back pain and neck pain and its impact in general have shown 23% of patients
reporting 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 much
more common in the elderly associated with functional limitations and difficulty in
performing daily life activities. Chronic persistent low back and neck pain is seen in
25% 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 among
individuals with back and neck pain in the United States continue to escalate. Recent
studies have shown significant increases in the prevalence of various pain problems
including low back pain.
Frequent use of opioids in managing chronic non-cancer pain has been a major issue
for health care in the United States placing a significant strain on the economy with
the majority of patients receiving opioids for chronic pain necessitating an increased
production of opioids, and escalating costs of opioid use, even with normal intake. The
additional costs of misuse, abuse, and addiction are enormous. Comorbidities including
psychological and physical conditions and numerous other risk factors are common in
spinal 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 of
spinal pain and its relevance to health care interventions.
Key words: Chronic pain, chronic spinal pain, chronic low back pain, chronic neck
pain, chronic thoracic pain, prevalence, health care utilization, loss of productivity,
interventional techniques, surgery, comorbid factors, socioeconomic effects, health
care impact
Therapeutic guidelines in chronic low back pain