Although neck pain is a common source of disability, little is known about its incidence and course. We conducted a population-based cohort study of 1100 randomly selected Saskatchewan adults to determine the annual incidence of neck pain and describe its course. Subjects were initially surveyed by mail in September 1995 and followed-up 6 and 12 months later. The age and gender standardized annual incidence of neck pain is 14.6% (95% confidence interval: 11.3, 17.9). Each year, 0.6% (95% confidence interval: 0.0-1.1) of the population develops disabling neck pain. The annual rate of resolution of neck pain is 36.6% (95% confidence interval: 32.7, 40.5) and another 32.7% (95% confidence interval: 25.5, 39.9) report improvement. Among subjects with prevalent neck pain at baseline, 37.3% (95% confidence interval: 33.4, 41.2) report persistent problems and 9.9% (95% confidence interval: 7.4, 12.5) experience an aggravation during follow-up. Finally, 22.8% (95% confidence interval: 16.4, 29.3) of those with prevalent neck pain at baseline report a recurrent episode. Women are more likely than men to develop neck pain (incidence rate ratio=1.67, 95% confidence interval 1.08-2.60); more likely to suffer from persistent neck problems (incidence rate ratio=1.19, 95% confidence interval 1.03-1.38) and less likely to experience resolution (incidence rate ratio=0.75, 95% confidence interval 0.63-0.88). Neck pain is a disabling condition with a course marked by periods of remission and exacerbation. Contrary to prior belief, most individuals with neck pain do not experience complete resolution of their symptoms and disability.

Population-based, prospective cohort. To estimate incidence and course of severity-graded low back pain (LBP) episodes in adults. Past studies report variable estimates that do not differentiate LBP severity. An incidence cohort of 318 subjects free of LBP and a course cohort of 792 prevalent cases was formed from respondents to a mailed survey. Incident, recurrent, persistent, aggravated, improved, and resolved episodes were defined by the Chronic Pain Questionnaire. The follow-up at 6 and 12 months was 74% and 62%, respectfully. Annual estimates were age and sex standardized. The cumulative incidence was 18.6% (95% confidence interval [CI], 14.2%-23.0%). Most LBP episodes were mild. Only 1.0% (95% CI, 0.0%-2.2%) developed intense and 0.4% (95% CI, 0.0%-1.0%) developed disabling LBP. Resolution occurred in 26.8% (95% CI, 23.7%-30.0%), and 40.2% (95% CI, 36.7%-43.8%) of episodes persisted. The severity of LBP increased for 14.2% (95% CI, 11.5%-16.8%) and improved for 36.1% (95% CI, 29.7%-42.2%). Of those that recovered, 28.7% (95% CI, 21.2%-36.2%)had a recurrence within 6months,and 82.4% of it was mild LBP. Younger subjects were less likely to have persistent LBP (incidence rate ratio, 0.88; 95% CI, 0.80-0.97) and more likely to have resolution (incidence rate ratio, 1.26; 95% CI, 1.02-1.56). Most new and recurrent LBP episodes are mild. Less than one third of cases resolve annually, and more than 20% recur within 6 months. LBP episodes are more recurrent and persistent in older adults.

Cohort study. To measure the prevalence and incidence of work absenteeism involving neck pain in a cohort of claimants to the Ontario Workplace Safety & Insurance Board (WSIB). According to workers' compensation statistics, neck pain accounts for a small proportion of lost-time claims. However, these statistics may be biased by an underenumeration of claimants with neck disorders. We studied all lost-time claimants to the Ontario WSIB in 1998 and used 2 methods to enumerate neck pain cases. We report the prevalence and incidence of neck pain using 2 denominators: (1) annual number of lost-time claimants and (2) an estimate of the Ontario working population covered by the WSIB. The estimated percentage of lost-time claimants with neck pain ranged from 2.8% (95% CI 2.5-3.3) using only codes specific for neck pain to 11.3% (95% CI 9.5-13.1) using a weighted estimate of codes capturing neck pain cases. The health care sector had the highest percentage of claims with neck pain. The annual incidence of neck pain among the Ontario working population ranged from 6 per 10,000 full-time equivalents (FTE) (95% CI 5-6) to 23 per 10,000 FTE (95% CI 20-27) depending on the codes used to capture neck pain. Male workers between the ages of 20 and 39 years were the most likely to experience an episode of work absenteeism involving neck pain. Neck pain is a common and burdensome problem for Ontario workers. Our study highlights the importance of properly capturing all neck pain cases when describing its prevalence and incidence.