How epidemiology contributes to the management of spinal disorders

Back pain constitutes a nearly universal experience. Point, one-year period and lifetime prevalence reach or exceed, in some European countries, 40%, 70% and 80%, respectively. No health care system is able to cope with the entire quantity and spectrum of cases. Clinically useful distinctions are urgently required. A basic classification distinguishes specific from non-specific cases. Non-specific back pain may then be graded on its actual severity in terms of pain intensity and disability. This already implies limited prognostic information. Staging assumes a more or less unidirectional course with definable phases and transition periods and definitely adds to prognosis (cf. the TNM-system in oncology). So far there seems to be no generally accepted staging system for chronic back pain, although some promising proposals can be presented. The disorder, once it has become chronic, has a rather unfavourable prognosis, although single episodes still have a high probability of completely resolving within a few weeks. An underestimated risk factor for a chronic-disabling course of current back pain is (besides its acute grade and stage) its previous history.