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Globally, musculoskeletal conditions including arthritis and back pain affect 1.5 billion people.1 They are the second greatest cause of global disability,1 and in the United States, arthritis and musculoskeletal conditions are the leading cause of disability and physician visits.2,3 Among U.S. community dwelling adults, 55.4 million people have doctor diagnosed arthritis and musculoskeletal disorders and 23.7 million of those people experience activity limitations, a figure greater than any other disease category (Fig. 57-1).2–4According to the 2012 National Health Interview Survey, age adjusted rates for musculoskeletal conditions may be as high as 54% of Americans, compared to 31% and 28% for cardiovascular and respiratory conditions, respectively.5 Ambulatory visits for arthritis and rheumatic conditions exceed 100 million annually (Table 57-1), and the total U.S. economic cost for musculoskeletal disease was estimated to be $213 billion in 2011.5 Indirect costs from lost earnings and services represent a particularly high proportion of this cost, since many people are affected during their most productive years.


Estimated number of persons in the United States in 2012 with limitation of activity attributable to specific disease categories. (Source: Adapted at https://www.cdc.28gov/nchs/nhis/nhis_2012_data_release.htm.)



Low Back and Neck Pain

Between 75% and 85% of people experience low back pain at some time during their lives.6 One study asked adults to recall the last 3 months, and estimated that 59 million patients self-report low back pain and 30 million report neck pain.7 Annually, 25% of adults report episodes of back pain which accounted for 53.8 million physician visits in 2012.5 Most episodes improve within a few weeks, but recurrences are common, and low back pain often becomes a chronic problem with intermittent, usually mild, exacerbations. In a small proportion of cases, the pain becomes constant and severe, and such cases account for a high proportion of the cost; one study found that 25% of the cases accounted for 90% of the costs.8

It is likely that the different conditions comprising the category “low back pain” (e.g., sprains and strains, disc herniations, spinal stenosis, spondylosis, and spondylolisthesis, facet abnormalities) have different causes. ...

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