The hidden cost of chronic pain: A narrative review of the environmental impact of outpatient spine and musculoskeletal care.

Health care is a major driver of greenhouse gas emissions and is closely intertwined with industrial processes responsible for air, water, and soil pollution. Chronic pain - particularly as it relates to spine and musculoskeletal diagnoses - comprises a significant portion of health care utilization and affects millions of people worldwide. Despite the prevalence of chronic spine and musculoskeletal pain, there has been limited discussion of the environmental impacts of outpatient clinics and interventional processes as they relate to these conditions. This narrative review explores the environmental impact related to diagnostics, pharmacologics, and common nonoperative interventional procedures utilized in the management of patients with chronic musculoskeletal and spine pain. Topics explored include energy utilization, production and disposal of pharmaceuticals, and waste production from interventional procedures. This study aims to educate providers involved in spine and musculoskeletal disease management regarding the possible environmental consequences of their practices. The article also focuses on modifying approaches to patient care to those that are more sustainable as well as highlighting areas in need of further investigation.