ABSTRACT
Pain is a major public health problem in the United States; 50 million Americans are partially or totally disabled from intractable pain. According to the American Pain Society, approximately 45% of all Americans seek care for persistent pain at some point in their lives. Back pain syndromes substantively contribute to the overall epidemiologic prevalence and fiscal gravity of pain disorders. As the leading cause of occupational disability in Americans below the age of 45 (Borenstein, 1998), the economic toll of back pain exceeds $16 billion in costs dedicated to therapeutic and/or management intervention (Burton & Erg, 1997). A significant issue is the progression of acute and subacute back pain to a condition of chronicity. Chronic back pain involves physiologic, psychologic, and sociocultural variables that exacerbate the scope of its effects and complicate both the clinical picture and amenability to intervention. Although an in-depth discussion of pain taxonomy, thoroughly detailed elsewhere in this text, is beyond the scope of the present chapter, it is important to note that persistent (back) pain can be perpetuated through numerous factors and can lead to maldynia (Table 16.1). Maldynic spinal pain involves heterogeneous mechanisms of peripheral and central sensitization, frequently produces a cognitive constellation in excess of apparent organic pathology, and increases the need for (and often the paradoxical inefficacy of) multidisciplinary management approaches.
