Chronic Back and Neck Pain: Care Seeking and Evidence

描述(由申请人提供)：与功能丧失相关的慢性下腰痛和颈部疼痛是常见且代价高昂的疾病，影响到至少4%-5%的人口。它们与巨大的痛苦负担以及每年超过500亿美元的医疗保健和社会成本有关。新技术和脊柱和疼痛诊所等专科诊所的增长导致患者使用提供者、诊断测试和治疗方式的组合。包括随机试验和系统评价在内的研究已经为特定单一治疗的有效性提供了实质性的证据基础，但缺乏关于联合治疗的信息。 根据十年前在北卡罗来纳州(北卡罗来纳州)进行的调查，我们建议进行一项以人群为基础的电话调查，以检查慢性背部和颈部疼痛的患病率和治疗方法。我们的具体目标是：1.描述慢性下腰痛和颈部疼痛在NC中的患病率以及这些人的人口学和临床特征。2.描述这一人群中的寻求护理模式。3.确定与更常见的提供者和提供者-治疗组合相关的人口统计学和临床因素。4.将常用的治疗方法和治疗组合与现有的治疗效果证据进行比较。我们将对随机选择的6,000个NC家庭进行调查，涉及慢性背部和颈部疼痛的患病率、全球和特定情况下的功能、抑郁、护理利用和护理满意度以及其他因素。我们预计，这项调查将确定400多名慢性疼痛患者。我们将考察在描述性分析、因素分析、Logistic回归分析和聚类分析中使用的护理组合。我们假设，随着技术的更多使用和多提供者的使用，寻求护理的人数将比20世纪90年代的S有所增加。使用循证医学的技术，然后我们将检查最常见的治疗方法和组合的证据，确定不基于证据的常见治疗方法，为未来的随机试验或实践模式的修改奠定基础。

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.