Unraveling the Triple Helix of Spine Pain: Spine Pain Diagnosis Rates Correlate with At-level Degenerative Spinal Condition Diagnoses
Beth Hogans1, Suraj Malhan2, Bernadette Siaton2, John Sorkin2
1Geriatric Research, Education, and Clinical Center (GRECC), VA Maryland Health Care System, Johns Hopkins University School of Medicine, 2University of Maryland School of Medicine
Objective:
This study aimed to investigate the association between spine pain diagnoses (SPDs) and degenerative spine conditions (DSCs) in a large sample of older U.S. adults
Background:
Spine pain, including pain of low back, cervical, and thoracic regions, is a pervasive health issue and leading cause of disability. Concomitantly, DSCs are prevalent, however associations of spine pain diagnoses with DSCs remain poorly characterized.
Design/Methods:
2017 CMS Medicare Standard Analytical 5% Sample Files was analyzed, including carrier and outpatient claims. The study population included 1.1 million older adults aged 65-100, with 12-months Part B Medicare enrollment, alive throughout 2017, and having 6 to 180 claims; Medicare Part C participants and Medicare Part B enrollees without active claims were excluded. Condition definition files were created utilizing ICD-10 codes. Frequencies, rates, and adjusted rates (logistic regression) were analyzed.
Results:
For those aged 65-100, low back pain was diagnosed in 20% and 17.2% of females and males respectively; Cervical spine pain in 10.1% and 7.8% respectively, and thoracic spine pain in 4.6% and 3.3% respectively. DSCs were prevalent, with 21.8% and 19.0% females and males respectively experiencing one or more (1+) lumbar spinal conditions, 9.5% and 8.4% respectively diagnosed with 1+ cervical spinal conditions, and 3.6% and 2.7% respectively having 1+ thoracic spinal conditions. Selected conditions, such as lumbar vertebral fatigue fractures, displayed exceptionally high rates of spine pain diagnosis, e.g., 96% and 90% in females and males respectively. Adjusted analysis showed that the rate of LBP for those with lumbar and lumbosacral DSCs was approximately 10-times the unaffected rates. Data showed high internal and external validity.
Conclusions:
This study provides conclusive evidence that degenerative spine conditions are associated with increased rates of spine pain diagnoses in older adults. The study highlights the need for further research to clarify the impact of age on pain perception.