Key Challenges to Future

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Lead Author(s): 

Kern Singh, MD
Gunnar Andersson, MD, PhD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

The financial cost associated with back pain is obviously enormous and, unfortunately, rising. Greater understanding of the causes of back pain and what leads to disability is needed to reduce this continually increasing trend.

One area of increased interest is the effect pre- and postoperative of spinopelvic parameters on treatment outcomes. Several previous investigations have described the magnitude of parameter correction afforded by surgical and non-surgical treatment modalities. However, many of these studies have featured small sample sizes and have rarely offered level I or II evidence. As such, there exists a need for large, prospective studies that investigate the true impact of influence of spinopelvic parameters on treatment outcomes for low back pain.

Most patients with back and neck pain are treated non-operatively, often with alternative treatments including such treatments as acupuncture, homeopathy, and massage. We know that enormous amounts of money are spent on many of these treatments, yet no quantifiable measures of cost or effect are yet available. The lack of information about treatments by chiropractors, physical therapists, and other care providers results in underestimated cost estimates for treatment of low back pain. There is also a lack of information on medical procedures done in offices or surgicenters, limiting estimates of cost and effectiveness of many interventional procedures, including many surgical procedures. These gaps in knowledge should be filled to obtain accurate estimates of the impact of back and neck pain on society.

Understanding why disc degeneration causes pain in some yet not in others is needed to address the burden of pain and disability and the significant economic impact low back pain treatments create on health care resources each year.


  • Fourth Edition

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