SPINE Volume 31, Number 23, pp 2724–2727
©2006, Lippincott Williams & Wilkins, Inc.
Back Pain Prevalence and Visit Rates
Estimates From U.S. National Surveys, 2002
Richard A. Deyo, MD, MPH,*†‡§ Sohail K. Mirza, MD, MPH,†§ and Brook I. Martin, MPH*§
Study Design. Review and analysis of data from two
U.S. national surveys in 2002.
Objectives. To examine the prevalence of back pain
and physician visits for back pain in the United States.
Summary of Background Data. National data on the prev-
alence of back pain become available only intermittently.
Methods. We summarized published data from the
2002 National Health Interview Survey (NHIS) on the
prevalence of back pain and compared it with earlier sur-
veys. We also analyzed the 2002 National Ambulatory
Medical Care Survey (NAMCS) to determine physician
visit rates for back pain.
Results. In the 2002 NHIS, there were 31,044 adult
respondents. Low back pain lasting at least a whole day in
the past 3 months was reported by 26.4% of respondents,
and neck pain was reported by 13.8%. Among racial
groups, American Indians and Alaska Natives had the
highest prevalence of low back pain, and Asian Ameri-
cans had the lowest. Prevalence generally declined with
greater levels of education and increasing income. Prev-
alence estimates were consistent with those from previ-
ous surveys, although methodologic differences limited
comparisons. NAMCS data suggested that the proportion
of all physician visits attributable to low back pain (2.3%
in 2002) has changed little since the early 1990s.
Conclusions. About one fourth of U.S. adults report
low back pain in the past 3 months; the proportion of
physician visits attributed to back pain has changed little
in the past decade.
Key words: prevalence, back pain, neck pain, trends,
physician visits. Spine 2006;31:2724–2727
Back pain is extremely common, but there are few recent
national data for the United States. Rising rates of imag-
ing, spine surgery, spinal injections, and use of comple-
mentary and alternative providers for back pain have
created an impression of increasing prevalence of back
pain.1–4The best population-based data on symptoms
come from well-designed national surveys, but such data
become only intermittently available. The recent release
of data from the 2002 National Health Interview Survey
(NHIS) and National Ambulatory Medical Care Survey
(NAMCS) provided an opportunity to examine recent
estimates of back pain prevalence in the United States,
visit rates to physician offices.
Most of the data presented here are derived from two national
surveys conducted by the National Center for Health Statistics,
a branch of the Centers for Disease Control and Prevention.
These surveys provide national estimates for a broad range of
health measures among the civilian, noninstitutionalized adult
population. We used them to examine the prevalence of back
pain, its demographic correlates, and the proportion of physi-
cian visits attributable to low back pain.
A recent summary of data from the NHIS provided an oppor-
tunity to examine the prevalence of back pain. The data in Tables
1 and 2 are summarized from the report.5We have not obtained
the data to perform additional analyses. The 2002 NHIS survey
sampled 36,161 households, from which there was an 88.1%
response rate. Among these households were 36,787 adults who
were eligible for the adult questionnaire, and data were actually
collected from 31,044 adults. The final response rate of 74.4% of
adults reflected a combination of nonresponse rates from family
units and the nonresponse rates from adults within responding
ing the probability of being sampled, which allowed estimates of
national percentages. The data presented here were age-adjusted
to the 2000 U.S. population by the National Center for Health
Statistics. The age groups used for age adjustment were 18 to 44
years, 45 to 64 years, 65 to 74 years, and 75 years or greater. Age
adjustment was used to permit comparison among demographic
subgroups that may have different age structures.5
We compared these results with previous surveys of back
pain prevalence, including a 1985 national survey conducted
by Louis Harris & Associates.6,7Adults over age 18 were sam-
population. Telephone numbers were randomly selected from
the Harris library of telephone directories, and the final two
digits were altered with random numbers. Weighting was ap-
plied to education, age, sex, and race to bring them into line
with actual proportions of the population. We also reviewed
data from a citywide population survey conducted in Dayton,
OH in 1973.8In this survey, families were chosen by a propor-
tionate random sampling scheme that blocked on demographic
characteristics to produce a sample with a distribution similar
to that found in then-current census data. Finally, we used data
from a previous U.S. government survey, the second National
Health and Nutrition Examination Survey (NHANES II).9This
involved 10,404 adults age 25 or older who completed both an
interview and a physical examination. Again, weights were in-
corporated to adjust for probability of selection, nonresponse,
Unfortunately, the definitions of back pain used in these sur-
From the Departments of *Medicine, †Orthopaedic Surgery, ‡Health
Services, and the §Center for Cost and Outcomes Research, University
of Washington, Seattle, WA.
Acknowledgment date: August 15, 2005. First revision date: Novem-
ber 8, 2005. Acceptance date: January 24, 2006.
Supported by Grant No. P60 AR 48093 from the National Institute for
Arthritis, Musculoskeletal and Skin Diseases.
The manuscript submitted does not contain information about medical
Federal funds were received in support of this work. No benefits in any
form have been or will be received from a commercial party related
directly or indirectly to the subject of this manuscript.
Address correspondence and reprint requests to Richard A. Deyo, MD,
MPH, Center for Cost and Outcomes Research, Box 359736, Harbor-
view Medical Center, 325 Ninth Avenue, Seattle, WA 98104; E-mail:
“During the past 3 months, did you have low back pain?” Re-
spondents were instructed to report pain that had lasted a whole
day or more and conversely, not to report fleeting or minor aches
or pains. In contrast, the Louis Harris survey asked about any
back pain in the past year, and the Dayton survey asked about
“frequent low back pain in the past year.” We assumed that back
less common than any back pain occurring in the past year, but
the 2002 NHIS results to fall between the estimates of 1 year
year. The NHANES survey asked “Have you ever had pain in
your back on most days for at least 2 weeks?” We assumed this
figure would be lower than the 2002 NHIS figure, which asked
only about back pain for a day, even though the NHANES ques-
tion applied to lifetime prevalence.
The NAMCS is a study of visits to medical office practices.
Each year, 3,000 physicians are randomly selected to provide
data on approximately 30 patient visits over a 1-week period.
The sample includes office-based physicians who are not feder-
ally employed, identified by the American Medical Association
and the American Osteopathic Association. Physicians in anes-
thesiology, pathology, and radiology are excluded, and only
office visits are captured (not hospital, nursing home, or house
calls). All 50 states and the District of Columbia are included.
For this report, we obtained NAMCS data for the years
1996 to 2002 to assess trends in office visits for back pain. For
this purpose, we used International Classification of Diseases
Version 9, Clinical Modification (ICD-9-CM) diagnosis codes
that identified the problem as being in the lumbar spine. In a
small number of cases, the location in the spine was not clear
from ICD codes, but we included patients whose chief com-
plaint indicated a low back problem. The codes were based
on a previously described algorithm,10which was recently up-
dated.11We excluded patients with pregnancy, malignancies,
injury resulting from motor vehicle accidents, or fractures.
In the 2002 NHIS, back pain was the most frequent type
of pain reported by respondents (Table 1). There were
26.4% of respondents who reported low back pain
within the past 3 months, while smaller percentages re-
ported severe headache, neck pain, or face or jaw pain.
This prevalence of back pain corresponds to an estimate
of over 54 million American adults who have experi-
enced low back pain in the past 3 months.
of 45 than among younger adults (Table 2). However, the
prevalence of back pain fell slightly among the oldest
adults, as noted in previous surveys.9Women were some-
what more likely than men to report back pain. Among
racial groups, American Indians and Alaska Natives had
had the lowest prevalence. White, black, and Hispanic re-
spondents fell between these extremes.
levels of education. Thus, respondents with less than a
high school diploma had a prevalence of almost 32%
versus approximately 22% among those with a bache-
lor’s degree or higher. Similarly, the prevalence of back
pain fell consistently with increasing levels of family in-
come. Regarding marital status, the prevalence of back
pain was highest among widowed adults and lowest
among those who had never married.
These prevalence estimates from 2002 seemed consis-
tent with those from earlier surveys (Table 3).12As ex-
pected, the 2002 prevalence estimates were substantially
lower than those reported by the Harris survey for “any
somewhat higher than estimates of “frequent low back
pain” in the past year, or the prevalence of back pain
Table 1. Prevalence of Various Pain Syndromes in the
Past 3 Months Reported by U.S. Residents, 2002
Age-Adjusted % (SE)
Low back pain
Migraine or severe headache
Face or jaw pain
Data are from National Health Interview Survey.5For each type of pain, respon-
dents were instructed to report pain that occurred during the past 3 months that
had lasted a whole day or more. They were instructed not to report fleeting or
minor aches and pains. Individuals may be represented in more than one row.
Table 2. Prevalence of Back Pain by Respondent
Age-Adjusted % With
Back Pain (SE)
75 yr or more
American Indian/Alaska Native
Native Hawaiian/Pacific Islander
2 or more races
Black and white
American Indian/Alaska Native and white
?High school diploma
High school diploma or GED
Bachelor’s degree or higher
$75,000 or more
Divorced or separated
Living with a partner
Data are from National Health Interview Survey.5
*Large standard error, reflecting small sample. Caution suggested by the
surveyors as data do not meet intended standard of precision.
2725Back Pain Prevalence•Deyo et al
lasting for at least 2 weeks. The 4 tabulated surveys to-
gether span some 30 years. However, because of differ-
ences in the way questions were asked and differences in
sampling methods, we cannot determine if there is a
trend in prevalence over time.
pain remained a fairly steady fraction of all office visits
between 1996 and 2002 (Figure 1). In 2002, lower back
pain accounted for approximately 2.3% of all office visits,
total number of office visits for all reasons increased from
about 734 million in 1996 to 890 million in 2002, the
increase seemed to be true for a wide range of conditions.
The estimate of 2.3% of visits is similar to the 2.8%
reported from 1989–1990 NAMCS data.13The higher
percentages reported in 1989–1990 may have been be-
cause cases were included as lumbar in that report even if
location in the spine was ambiguous from ICD-9 codes.
The NHIS provides updates of back pain prevalence in
the United States. The survey questions are not compa-
rable with those used in previous national surveys, so we
cannot determine if there is a trend in prevalence, al-
though the recent values seem consistent with earlier sur-
veys. We also cannot determine any possible changes in
pain severity, diagnoses, or work absenteeism. Another
review of trend data, including international estimates,
suggested that the prevalence of low back pain has not
changed significantly over the past 30 years.14
Other estimates include a value of 41% of American
adults between the ages of 26 and 44 years having had
back pain in the past 6 months.14Several European stud-
ies have examined the prevalence of any back pain in the
last month, producing estimates that center around
40%.14The estimate derived from the 2002 NHIS for
3-month prevalence is somewhat lower, but this may be
related to the instruction to ignore trivial back pain in
this Health Interview Survey.
These data confirm earlier findings suggesting that the
levels of education and income.8,9It remains unclear
whether this is a consequence of more ergonomically de-
manding jobs, greater life stress, or other factors. The data
also identify substantial racial differences in the prevalence
of back pain, which may warrant further investigation. In
comparison with other body sites, back pain remains the
most common pain problem reported by U.S. adults.
pain has remained relatively stable. In contrast, there is
and alternative medicine,2and injection procedures.3One
hypothesis would be that the prevalence of back pain is
relatively stable, but therapy is becoming more intensive,
with greater “per patient” use of these treatments.
Table 3. Estimates of U.S. Prevalence of Back Pain in Various Surveys
Any Back Pain in Past Year
(%) (Louis Harris Survey
Group, 1985; n ? 1,254)
At Least 1 Day of Back Pain
in Past 3 Months (%)
(NHIS, 2002; n ? 31,044)
“Frequent” LBP in Past 12
Months (%) (Dayton, Ohio,
1973; n ? 2,782)
Lifetime Prevalence of LBP
Lasting at Least 2 Weeks
(NHANES II, 1976–1980)
Over the age of 65
Figure 1. Percent of office visits
for low back pain as primary di-
agnosis among adults 18 years or
older (NAMCS, 1996–2002).
2726 Spine•Volume 31•Number 23•2006
generalize that about half of adults have low back pain
during any given year and about two thirds have low back
at least a day of back pain during the past 3 months, and
about 15% of adults report “frequent” back pain or pain
lasting greater than 2 weeks annually.9
● Low back pain remains the most common type
of pain reported by U.S. adults; 26.4% report back
pain lasting at least a day in the past 3 months.
● Back pain prevalence falls with increasing levels
of education and income.
● The proportion of all physician visits attributed
to back pain has remained fairly steady since 1990.
● The prevalence of back pain estimated from
2002 national data is consistent with estimates
from earlier decades, but differences in question-
naire wording make it impossible to determine if
there are significant trends.
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2727 Back Pain Prevalence•Deyo et al