THE GLOBAL BURDEN OF LOW BACK PAIN: ESTIMATES FROM THE GLOBAL BURDEN OF DISEASE 2010 STUDY
 
   

The Global Burden of Neck Pain:
Estimates From the Global Burden of Disease 2010 Study

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:
   Frankp@chiro.org
 
   

FROM:   Ann Rheum Dis. 2014 (Jul);   73 (7):   1309–1315 ~ FULL TEXT

Damian Hoy, Lyn March, Anthony Woolf, Fiona Blyth, Peter Brooks, Emma Smith, Theo Vos, Jan Barendregt, Jed Blore, Chris Murray, Roy Burstein, Rachelle Buchbinder

University of Queensland,
Herston, Queensland, Australia.


OBJECTIVE:   To estimate the global burden of neck pain.

METHODS:   Neck pain was defined as pain in the neck with or without pain referred into one or both upper limbs that lasts for at least 1 day. Systematic reviews were performed of the prevalence, incidence, remission, duration and mortality risk of neck pain. Four levels of severity were identified for neck pain with and without arm pain, each with their own disability weights. A Bayesian meta-regression method was used to pool prevalence and derive missing age/sex/region/year values. The disability weights were applied to prevalence values to derive the overall disability of neck pain expressed as years lived with disability (YLDs). YLDs have the same value as disability-adjusted life years as there is no evidence of mortality associated with neck pain.

RESULTS:   The global point prevalence of neck pain was 4.9% (95% CI 4.6 to 5.3). Disability-adjusted life years increased from 23.9 million (95% CI 16.5 to 33.1) in 1990 to 33.6 million (95% CI 23.5 to 46.5) in 2010. Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability as measured by YLDs, and 21st in terms of overall burden.

CONCLUSIONS:   Neck pain is a common condition that causes substantial disability. With aging global populations, further research is urgently needed to better understand the predictors and clinical course of neck pain, as well as the ways in which neck pain can be prevented and better managed.

KEYWORDS:   Epidemiology; Health services research; Outcomes research



From the FULL TEXT Article:

INTRODUCTION

Neck pain occurs commonly throughout the world and causes substantial disability and economic cost. [1] The pain and disability associated with neck pain have a large impact on individuals and their families, communities, healthcare systems and businesses. [2–4] Economic consequences include the cost of healthcare, reduced work productivity, work absenteeism and insurance. As part of the Global Burden of Disease 2010 Study (GBD 2010), the global burden of musculoskeletal (MSK) conditions was estimated. Burden was expressed in disability-adjusted life years (DALYs).

This paper details the methods and results for estimating the global burden of neck pain for GBD 2010. It is part of a series of articles. The main overall articles for GBD 2010 were published in the Lancet, [5–9] and the MSK-specific papers are published in this issue of Annals of Rheumatic Diseases. [10–18] One of these papers give an in-depth description of the methods used for estimating the global burden of the MSK conditions [15] and this should be read in conjunction with the current paper.



DISCUSSION

      Estimates of the global burden of neck pain

This is the first time the global burden of neck pain has been estimated. The methods were complex and the process took almost 6 years. The results show that the prevalence and burden from neck pain is high around the world. Out of the 291 conditions studied in GBD 2010, neck pain was found to rank 21st in terms of overall burden and 4th in terms of overall disability. In addition, the study has identified that neck pain prevalence peaks in the middle age groups. With improved child survival and aging populations throughout the world, especially in lowincome and middle-income countries, the number of people experiencing neck pain will increase substantially over the coming decades.

      Strengths and limitations

The greatest strength of the neck pain burden estimates in GBD 2010 is the extensive series of systematic reviews that were undertaken to obtain data for making the estimates and the large number of captured studies. Risk of bias was also considered and studies considered to be at high risk of bias were excluded from the analysis.

Further strengths included:

(1)   the development of a new case definition and set of functional health states for neck pain;

(2)   the development of a set of disability weights for these health states, which were derived through community-based
and health professional surveys in a number of countries; and

(3)   use of a new, more advanced version of DisMod that can

(A)   pool all data rather than rely on a ‘pick and choose’ method,

(B)   perform meta-regression to make data points from different studies more comparable,

(C)   use data to fill in missing information, and

(D)   carry forward uncertainty throughout the analysis.

Despite these strengths, there were some limitations. The functional domains in GBD 2010 refer to body functions and structures (eg, vision) as well as more complex human operations (eg, mobility), but they are not as inclusive as the WHO International Classification of Functioning, Disability and Health. They do not refer to broader aspects of life such as participation, well-being, carer burden, economic impact and burden of disease from the individual’s perspective. It is important that burden of disease estimates are supplemented with this information to consider the full impact of a condition in a population.

Health state valuations are complex and can lead to very different answers. GBD 2010 endeavoured to respond to previous criticism that existing DWs were derived by a small group of international public health experts. Consequently, GBD 2010 undertook large-scale population and internet surveys to ask the general public to provide the health state valuations. That meant each health state had to be described in lay terms. Pilot testing revealed that descriptions of more than 30–40 words could not be absorbed. There will be ongoing work on DWs to explore what difference small changes in the wording of health state descriptions can make to the ultimate health state valuation.

Prevalence data for many countries and a number of regions were unable to be found. In GBD, no individual data point is adopted as reflecting the truth. Instead, statistical models are employed to all available data sources with corrections built in for risk of data bias in order to best predict true values of any epidemiological entity of interest. In regions with lots of data, estimates reflect the available data or at least find reasonable middle ground between what often are rather heterogeneous data sources. For regions with little or no data, the estimates will borrow strength from all other data and any available predictors of disease outcome. The level of uncertainty around each estimate reflects the strength of the underlying data to make a particular region’s estimate.

It is a guiding principle in GBD to make estimates even if data are sparse. The alternative of not including some conditions that are known to be important contributors elsewhere is that it would give policy makers the impression that the condition is not important in their country. Also, in the studies that were captured, there was considerable methodological variation, especially relating to the prevalence period and case definition used making pooling of the data difficult. While ‘neck or shoulder’ pain was assumed to be a proxy for ‘neck’ pain, future GBD efforts may benefit from adjusting ‘neck or shoulder’ to ‘neck’ pain using the same Bayesian meta-regression method as for the other anatomical definition variations. In GBD 2010, the burden of neck pain may be overestimated due to the inclusion of shoulder pain.

Researchers are encouraged to adopt recent recommendations on defining neck pain in epidemiological studies to assist future reviews, enable comparisons between countries and improve our understanding of neck pain. [3]

While using the MEPS study had the advantage of estimating the distribution of severity while taking comorbidity into account, it also had limitations. There is likely to have been some level of recall bias despite there being five follow-up points over 2 years. Also, MEPS may not be representative of the health state experience for neck pain across the globe. In low-income and middle-income countries, where services for the prevention and management of neck pain are not as extensive as the USA, the health state experience could be different.

      Suggested further research

There is clearly a need for further research on the natural history of neck pain. Long-term longitudinal population-based studies would provide important information on the natural history, average duration and disability associated with an episode of neck pain. Incorporating this research with pain diaries to track the daily patterns of pain and disability would add greater depth to this research. With expanding and aging populations in many low-income and middle-income countries, the burden from neck pain in these areas will grow significantly over coming decades. There is an urgent need to increase our understanding and attempt to mitigate the growing burden of neck pain in low/middle-income countries.



CONCLUSION

Neck pain is one of the main causes of disability throughout the world and requires greater attention from governments, health service providers and researchers. Further research is urgently needed to better understand the predictors and clinical course of neck pain across different settings, particularly in low-income and middle-income countries, and the ways in which neck pain can be prevented and better managed.



References:

  1. Hogg-Johnson, S, van der Velde, G, Carroll, LJ et al.
    The Burden and Determinants of Neck Pain in the General Population:
    Results of the Bone and Joint Decade 2000–2010 Task Force
    on Neck Pain and Its Associated Disorders

    Spine (Phila Pa 1976). 2008 (Feb 15); 33 (4 Suppl): S39–51

  2. Haldeman S, Carroll L, Cassidy JD.
    Findings from the bone and joint decade 2000 to 2010 task force on neck pain and its associated disorders.
    J Occup Environ Med 2010;52:424–7.

  3. Guzman, J., Hurwitz, E.L., Carroll, L.J. et al.
    A New Conceptual Model Of Neck Pain: Linking Onset, Course, And Care
    Results of the Bone and Joint Decade 2000–2010 Task Force
    on Neck Pain and Its Associated Disorders

    Spine (Phila Pa 1976). 2008 (Feb 15);   33 (4 Suppl):   S14–23

  4. Manchikanti L, Singh V, Datta S, et al.
    Comprehensive review of epidemiology, scope, and impact of spinal pain.
    Pain Physician 2009;12:E35–70.

  5. Murray CJ, Vos T, Lozano R, et al.
    Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.
    Lancet 2013;380:2197–223.

  6. Lozano R, Naghavi M, Foreman K, et al.
    Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.
    Lancet 2013;380:2095–128.

  7. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, et al.:
    Years Lived with Disability (YLDs) for 1160 Sequelae of 289 Diseases
    and Injuries 1990-2010: A Systematic Analysis for the
    Global Burden of Disease Study 2010

    Lancet. 2012 (Dec 15); 380 (9859): 2163–2196

  8. Lim SS, Vos T, Flaxman AD, et al.
    A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.
    Lancet 2013;380:2224–60.

  9. Salomon JA, Vos T, Hogan DR, et al.
    Common values in assessing health outcomes from disease and injury: disability weights measurement study for the Global Burden of Disease Study 2010.
    Lancet 2013;380:2129–43.

  10. Cross M, Smith E, Hoy D, et al.
    The global burden of rheumatoid arthritis: estimates from the Global Burden of Disease 2010 study.
    Ann Rheum Dis 2014; Submitted.

  11. Cross M, Smith E, Hoy D, et al.
    The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study.
    Ann Rheum Dis 2014; Submitted.

  12. Hoy D, March L, Brooks P, et al.
    The Global Burden of Low Back Pain:
    Estimates from the Global Burden of Disease 2010 study

    Ann Rheum Dis. 2014 (Jun); 73 (6): 968–974

  13. Hoy D, March L, Woolf A, et al.
    The Global Burden of Neck Pain:
    Estimates From the Global Burden of Disease 2010 Study

    Ann Rheum Dis. 2014 (Aug); 73 (8): 1462–1469

  14. Hoy D, Smith E, Blyth F, et al.
    Reflecting on the global burden of musculoskeletal conditions: lessons learnt, next steps.
    Ann Rheum Dis 2014; Submitted.

  15. Hoy D, Smith E, Cross M, et al.
    The Global Burden of Musculoskeletal Conditions for 2010:
    An Overview of Methods

    Ann Rheum Dis 2014;73:982–9

  16. Sanchez-Riera L, Carnahan E, Vos T, et al.
    Global Burden Attributable to Low Bone Mineral Density.
    Ann Rheum Dis 2014; Submitted.

  17. Smith E, Hoy D, Cross M, et al.
    The global burden of gout: estimates from the Global Burden of Disease 2010 study.
    Ann Rheum Dis 2014; Submitted.

  18. Smith E, Hoy D, Cross M, et al.
    The Global Burden of Other Musculoskeletal Disorders:
    Estimates From the Global Burden of Disease 2010 Study

    Ann Rheum Dis. 2014 (Aug); 73 (8): 1462–1469

  19. Hoy DG, Protani M, De R, et al.
    The epidemiology of neck pain.
    Best Pract Res Clin Rheumatol 2010;24:783–92.

  20. Hoy DG, Brooks P, Blyth F, et al.
    The epidemiology of low back pain.
    Best Pract Res Clin Rheumatol 2010;24:769–81.

  21. Hoy D, Brooks P, Woolf A, et al.
    Assessing risk of bias in prevalence studies:
    modification of an existing tool and evidence of interrater agreement.
    J Clin Epidemiol 2012;65:934–9.

  22. Hill J, Lewis M, Papageorgiou AC, et al.
    Predicting persistent neck pain: a 1-year follow-up of a population cohort.
    Spine 2004;29:1648–54.

  23. Demyttenaere K, Bruffaerts R, Lee S, et al.
    Mental disorders among persons with chronic back or neck pain: results from the World Mental Health Surveys.[see comment].
    Pain 2007;129:332–42.

  24. March LM, Brnabic AJM, Skinner JC, et al.
    Musculoskeletal disability among elderly people in the community.
    Med J Australia 1998;168:439–42.

  25. US National Institutes of Health.
    US National Health Information surveys. cited;
    http://www.cdc.gov/nchs/nhis.htm

  26. US Centres for Disease Control and Prevention.
    National Health and Nutrition Examination Survey. Cited.
    http://www.cdc.gov/nchs/nhanes.htm

  27. Agency for Healthcare Research and Quality.
    United States Medical Expenditure Panel Survey 2000–2009.
    Rockville, United States: Agency for Healthcare Research and Quality, 2010.

  28. Murray CJL, Lopez AD.
    The global burden of disease: a comprehensive assessment of mortality and disability
    from diseases, injuries and risk factors in 1990 and projected to 2020.
    Boston: Harvard University Press, 1996.

  29. Ahmadi B, Boschi-Pinto C, Lopez A, et al.
    Age standardization of rates: a new WHO standard.
    Geneva: World Health Organisation, 2001.



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