Chronic Back and Neck Pain: Care Seeking and Evidence

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DESCRIPTION (provided by applicant): Chronic low back and neck pain associated with functional incapacity are common and costly conditions affecting at least 4-5% of the population. They are associated with a large burden of suffering, as well as health care and social costs of over $50 billion per year. New technology and the growth of specialty practices such as spine and pain clinics have led to patients using combinations of providers, diagnostic tests and therapeutic modalities. Research including randomized trials and systematic reviews have provided a substantial evidence base regarding the effectiveness of specific single treatments, but information on combinations of treatments is lacking. Building on surveys conducted in North Carolina (NC) a decade ago, we propose to conduct a population- based telephone survey to examine the prevalence of and care used for chronic back and neck pain. Our specific aims are to: 1 .Describe the prevalence of chronic low back and neck pain in NC and the demographic and clinical characteristics of these individuals. 2. Describe the care seeking patterns among this population. 3. Identify demographic and clincial factors associated with the more common provider and provider-treatment combinations. 4. Compare commonly used treatments and combinations of treatments with current evidence of therapeutic effectiveness. We will conduct a survey of 6,000 randomly selected NC households addressing the prevalence of chronic back and neck pain, global and condition-specific functioning, depression, care utilization and satisfaction with care, as well as other factors. We anticipate that this survey will identify over 400 patients with chronic pain. We will examine the combinations of care used in descriptive analyses, factor analysis, logistic regression analysis and cluster analysis. We hypothesize that care seeking will have increased compared with the 1990's, with greater use of technology and multiple provider use. Using the techniques of evidence-based medicine, we will then examine the evidence for the most common treatments and combinations, identifying common treatments that are not based on evidence, setting the stage for future randomized trials or modifications in practice patterns.