Chronic Primary Pain of the Spine: an Integrative Perspective Part 1


The aim of this study is to conduct a narrative review of the literature emphasizing current models of non-specific low back and neck pain with an emphasis on chronic and disabling pain. We include its risk factors, etiology, pathophysiology, and differential diagnosis. Emphasis is also placed on variables of chronification and the persistence of this type of pain. Our secondary aim was to provide foundational knowledge before advancing the discussion to a proposal of evidence-based management strategies for patients suffering from chronic primary spine pain in a subsequent follow-up article. A review of the English medical literature was performed using search terms “chronic low back pain” OR “chronic neck pain” AND “primary,” “differential diagnosis,” “pathophysiology,” “functional imaging” and “risk factors.” Additional searches were made using Google Scholar and PubMed search engines through January 17, 2020. A total of 112 articles were used. Acute and chronic spine pain differ significantly in risk factors, pathophysiology, prevalence, and differential diagnosis. Chronic spinal pain is multifactorial in nature, and that proposed causes of chronicity and pain-related disability span the entire spectrum of the biopsychosocial domain. Chronic low back and neck pain poses a significant global threat of disabling and burdensome quality of life. Because pain is a complex multifactorial integrative experience, the scientific literature reports an abundance of multidimensional risk factors associated with the persistence of pain beyond normal healing times. Understanding the nature of chronic primary spinal pain will provide clinicians with necessary and valuable insights for patient care along the complex and variable spectrum of the biopsychosocial approach.

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disability-adjusted life years


International Association for the Study of Pain


International Classification of Disease 11th Edition


quantitative sensory testing


chronic low back pain


post-traumatic stress disorder


patient health questionnaire-9


socioeconomic status


body mass index




positron emission tomography


magnetic resonance imaging


translocator protein 18 kDa


long-term potentiation


long-term depression


default mode network


medial prefrontal cortex


periaqueductal gray-rostral ventromedial medulla


dorsal anterior cingulate cortex


nucleus accumbens


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Alec J. Domjan, DC for participation during early concept development. Patrick J. Battaglia, DC for concept development and manuscript revision.

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NWK was a major contributor in concept development. TJW, CLB, NAH, and NWK performed the literature search, analyzed results, drafted, revised, and approved the final manuscript. TJW was a major contributor in writing the manuscript.

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Correspondence to Timothy J. Williamson.

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Williamson, T.J., Bolles, C.L., Hedges, N.A. et al. Chronic Primary Pain of the Spine: an Integrative Perspective Part 1. SN Compr. Clin. Med. 3, 461–472 (2021).

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  • Chronic pain
  • Spine
  • Low back pain
  • Neck pain
  • Risk factors
  • Pathophysiology