Evidence & Methods
Knowledge of the incidence of low back pain within a society may be useful at the policy level, specifically by establishing priorities for care and providing insight for estimates into potential societal costs.
In this study using information obtained from NEISS, the authors found that about 2 million people in the United States went to emergency rooms for low back pain between 2004 and 2008, accounting for about 3% of all ER visits.
This information is valuable as a snapshot of back pain at the societal level. It can serve as an impetus for further investigation. As with most database analyses, the information is insufficiently specific to be used to guide care of individual patients, as the authors have acknowledged in their discussion of the weaknesses inherent in such studies.
—The Editors
Low back pain is one of the most common conditions prompting individuals to seek medical care [1], [2], [3], [4]. Because of its wide prevalence, especially among working age individuals, low back pain as a whole has a substantial impact on economic productivity and health care resource utilization. The point prevalence of low back pain is estimated to be in the range of 20% to 30% for the general population [1] with individuals aged 45 to 65 years thought to be at greatest risk [3]. Among the American population, low back pain is the fifth most common reason individuals seek medical care [2], [3], and 30–50 billion health care dollars are spent on the treatment of this condition annually [2], [3], [4].
There are numerous factors that can result in symptoms of low back pain. Specific etiologies, such as tumors, spinal instability, and infections, may be immediately treatable. There are other conditions such as degenerative disc disease and spondylotic processes whose contribution to back pain is incompletely understood. Still, in some patients, nonspecific factors are felt to contribute to the origin of back pain, and these individuals may be especially difficult to effectively treat [4]. Some authors have maintained that close to 85% of patients with acute back pain have nonspecific etiologies for their condition [2], [3], [4], [5]. Such individuals may be at greater risk for developing chronic back pain, and it is these cases that bear a disproportionate share of the burden of health care costs related to back pain [2], [4]. In fact, less than 5% of patients with low back pain consume up to 75% of attributable health care costs [6].
Obstacles to the effective study of this condition include its near ubiquity among the population in terms of lifetime risk, as well as the disparate number of conditions that can manifest with symptoms of low back pain. In terms of nonspecific back pain, a number of factors have been postulated to play a role in its development, including age [7], [8], [9], [10], sex [8], [10], [11], genetic predisposition [12], [13], [14], [15], occupation [7], [8], [16], [17], smoking [6], [9], [13], [14], [18], race [10], job satisfaction [16], [19], psychological issues [2], [19], anthropometry, and posture [10]. Limitations within prior investigations, such as sample size and a reliance on select populations of unique occupation or ethnic group, have limited the applicability of findings to the population at large. At present, no large study has been able to identify the incidence of low back pain necessitating emergency medical evaluation, or risk factors for its development, among the general American population.
This investigation sought to determine the incidence and epidemiology of low back pain necessitating emergency medical evaluation in the United States from 2004 to 2008. In addition, this research also endeavored to describe the effect of age, sex, and race on the development of low back pain. To the best of our knowledge, this report is the first of its kind, documenting findings that may be representative of the general American population as a whole.