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
body mass index
positron emission tomography
magnetic resonance imaging
translocator protein 18 kDa
default mode network
medial prefrontal cortex
periaqueductal gray-rostral ventromedial medulla
dorsal anterior cingulate cortex
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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). https://doi.org/10.1007/s42399-021-00772-z
- Chronic pain
- Low back pain
- Neck pain
- Risk factors