Spinal pain, which includes pain in the neck, upper back, and lower back, is a major health problem that affects millions of people around the world and is a leading cause of disability. Although much research is done on spinal pain and related pain in the limbs, torso, abdomen, or pelvis, studies are difficult to compare and combine because researchers often measure different health outcomes.

To solve this problem, experts can create "Core Outcome Sets," or COSs. A COS is a standardized list of outcomes that should be measured and reported in all studies for a specific health condition. Using a COS helps ensure that all research on a topic collects the same essential information, making it easier to compare results across different studies.

This research project was a systematic review, which is a thorough process of finding and analyzing all available research on a specific question. The goal was to identify and examine all published Core Outcome Sets designed for assessing spinal pain. The review also aimed to find common themes among these sets, grouping the recommended measurements by the part of the body affected and by the type of measurement used. These measurement types included those reported by patients themselves, as well as physical, biological, psychological, social, and environmental factors.

To conduct the review, researchers followed established guidelines for systematic reviews (known as PRISMA) and publicly registered their study plan in a database called PROSPERO. They performed an extensive search of 13 electronic databases and other sources of information (often called grey literature) for relevant studies published between the year 2000 and April 2025. Two reviewers worked independently to determine which studies should be included and to assess their quality. They then extracted the data, identifying which health aspects, or "domains," each COS recommended measuring. Finally, they analyzed this information to categorize the domains.

The search resulted in 13 studies that met the inclusion criteria. These studies presented Core Outcome Sets for pain in the neck (cervical spine, 4 studies), the mid and lower back (thoracolumbar spine, 1 study), and the lower back (lumbar spine, 8 studies).

The most common type of measurement recommended was "patient-reported outcome measures," where patients directly provide information about their health, often through questionnaires. The most frequently recommended domains to measure were:

• Physical function (a person's ability to perform physical tasks), included in 9 studies.
• Pain intensity (how severe the pain feels), included in 8 studies.
• Participation in work or daily activities, included in 7 studies.
• Disability (how the pain limits a person's life), included in 6 studies.

A key finding was that few of the existing Core Outcome Sets included domains related to psychological, social, environmental, or physiological (biological) factors. This indicates that these important dimensions of a person's experience with spinal pain are often not measured.

This systematic review has identified the key measurements currently being used for spinal pain while also revealing significant gaps, particularly in assessing the biological, psychological, and social aspects of the condition. These findings can assist researchers, clinicians, and health policymakers in choosing appropriate outcomes for future studies and clinical care. The authors suggest that a good next step would be to conduct a "Delphi study," a research method that brings experts together to build consensus. The goal would be to develop an internationally agreed-upon "Essential Universal Set" of measurements for spinal pain that comprehensively includes these missing biological, psychological, and social dimensions.