SPINE Volume 33, Number 8, pp 909 –913 ©2008, Lippincott Williams & Wilkins Pain in the Back and Neck Are With Us Until the End A Nationwide Interview-Based Survey of Danish 100-Year-Olds Jan Hartvigsen, DC, PhD,*† and Kaare Christensen, MD, PhD‡ Study Design. Nationwide interview survey. Objectives. To determine the 1-month prevalence and impact of back and neck pain among centenarians and to investigate associations between back and neck pain and other health measures such as physical function, depres- sion, comorbidity, and self-rated health. Summary of Background Data. To our knowledge prevalence and impact of back and neck pain has never been studied among the oldest old. Methods. Information on the 1-month prevalence of back and neck pain and bothersomeness of back and neck pain was collected using face-to-face interviews in a na- tionwide survey of Danish centenarians. In addition, in- formation on physical and mental functional abilities, self-rated health, and comorbidities were collected. Results. Two hundred fifty-six persons completed the interview (response rate, 56%). Twenty-nine percent of women and 17% of men had experienced back pain, and 23% of women and 19% of men had experienced neck pain during the past month. This was comparable to an- other nationwide Danish survey of younger seniors. Twenty-one percent had been bothered by back pain ei- ther when moving, resting, or sleeping. Poor overall physical function, bad self-rated health, and higher de- pression score were associated with higher prevalence of back and neck pain. Conclusion. Back pain and neck pain continue to be common and bothersome complaints even into extreme old age. Thus, back pain and neck pain are not limited to working populations. Key words: back pain, neck pain, centenarians, geriat- rics, prevalence. Spine 2008;33:909 –913 Pain has been called “the fifth vital sign” in old age, 1 and back pain and neck pain are among the most prevalent pain conditions in older persons. 2 Furthermore, back and neck pain significantly influences the functional sta- tus and quality of life in the elderly 3,4 and have been shown to be closely related to overall poor health and many comorbidities. 5 Life expectancy has been increas- ing steadily all over the western world for more than 150 years, 6 and while just a few decades ago reaching the age of 100 was close to a national event, the number of cen- tenarians has now increased 15-fold in just 30 years in some countries, 7 and is currently doubling every 10 years. 8 Enormous amounts of money have been spent on treatment and prevention of back pain over the years, but unfortunately so far the investment has not yielded the desired results—at least not at a large scale. 9,10 Therefore one can rightfully question whether health politicians, patients, clinicians, and researchers have a correct understanding of the underlying nature of back and neck pain, i.e., are back and neck pain indeed pre- ventable and curable conditions, or are they mostly part of human life and the best we can do is to encourage rational behavior and ensure relief once the inevitable episodes of pain occur? Studying disease over the entire human lifespan can help us understand such underlying causes and mecha- nisms. If for instance the occurrence and characteristics of a condition are very similar regardless of age, it may be because the underlying disposition to the condition is not strongly related to external exposures because these tend to vary dramatically over a lifetime. In the case of back and neck pain for example, much effort have been fo- cused on eliminating suspected injurious work-related exposures, but if the conditions are just as common and similar in nonworking populations such as children and retired or very old persons, such a strategy may not be feasible. We had the opportunity to study back and neck pain in centenarians using the Danish 1905 cohort compris- ing all Danes born in 1905 and alive in 2005 and to compare the prevalence of back and neck pain in this cohort with results from another population-based study comprising all Danish twins aged 70 and older. Specifically, we sought to answer the following research questions: (1) What is the prevalence and impact of back and neck pain in 100-year olds? and (2) Does the prevalence and character- istics of back and neck pain appear to differ between cente- narians and younger groups of seniors? Methods We used information from the Danish 1905-Cohort study and the Longitudinal Study of Aging Danish Twins (LSADT). Danish 1905-Cohort Study was initiated in 1998, and has been described in detail elsewhere. 11 In brief, all Danes born in 1905 were located through the Danish Civil Registration Sys- tem (DCRS) and approached irrespective of residence, health, From the *Clinical Locomotion Science, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej, Odense M, Denmark; †Nordic Institute of Chiropractic and Clinical Biomechanics, part of Clinical Locomotion Science, Forskerparken, Odense M, Denmark; and ‡Epidemiology, Institute of Public Health, University of Southern Denmark, JP Winsløwsvej, Odense C, Denmark. Acknowledgment date: October 9, 2007. Revision date: November 7, 2007. Acceptance date: November 7, 2007. The manuscript submitted does not contain information about medical device(s)/drug(s). Institutional 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. The study was funded by the Danish National Research Foundation. Address correspondence and reprints to Dr. Jan Hartvigsen, Institute of Sports Science and Clinical Biomechanics, University of Southern Den- mark, Campusvej 55, 5230 Odense M, Denmark; E-mail: jhartvigsen@ health.sdu.dk 909