title: Spine-area pain in military personnel: a review of epidemiology, etiology, diagnosis, and treatment.
abstract: BACKGROUND
  Nonbattle illnesses and injuries are the major causes of unit attrition in modern warfare. Spine-area pain is a common disabling injury in service members associated with a very low return-to-duty (RTD) rate.
  
  
  OBJECTIVE
  To provide an overview of the current understanding of epidemiology, possible causes, and relative prognosis of spine-area pain syndromes in military personnel, including a discussion of various treatment options available in theaters of operation.
  
  
  METHODS
  Literature review.
  
  
  METHODS
  Search focusing on epidemiology, etiology and associative factors, and treatment of spinal pain using electronic databases, textbooks, bibliographic references, and personal accounts.
  
  
  RESULTS
  Spine-area pain is the most common injury or complaint "in garrison" and appears to increase during training and combat deployments. Approximately three-quarters involve low back pain, followed by cervical and midback pain syndromes. Some predictive factors associated with spine-area pain are similar to those observed in civilian cohorts, such as psychosocial distress, heavy physical activity, and more sedentary lifestyle. Risk factors specific to military personnel include concomitant psychological trauma, g-force exposure in pilots and airmen, extreme shock and vibration exposure, heavy combat load requirements, and falls incurred during airborne, air assault, and urban dismounted ground operations. Effective forward-deployed treatment has been difficult to implement, but newer strategies may improve RTD rates.
  
  
  CONCLUSIONS
  Spine-area pain syndromes comprise a major source of unit attrition and are often the result of duty-related burdens incurred during combat operations. Current strategies in theaters of operation that may improve the low RTD rates include individual and unit level psychological support, early resumption of at least some forward-area duties, multimodal treatments, and ergonomic modifications.
authors.affiliation: Pain Management Division, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA. scohen40@jhmi.edu
authors.forename: Steven P
authors.initials: SP
authors.lastname: Cohen
authors.forename: Rollin M
authors.initials: RM
authors.lastname: Gallagher
authors.forename: Shelton A
authors.initials: SA
authors.lastname: Davis
authors.forename: Scott R
authors.initials: SR
authors.lastname: Griffith
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Carragee
mesh_terms: D006801:Humans; D008889:Military Personnel; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D059408:Pain Management; D013131:Spine