The prevalence of chronic low back pain (LBP) in North Carolina increased significantly from 3.9% in 1992 to 10.2% in 2006. This rise was observed across all age, gender, and racial groups. Despite similar symptom severity and general health, more people sought care in 2006 (84.0%) compared to 1992 (73.1%). The study used a cross-sectional telephone survey of North Carolina households, with identical definitions of chronic LBP for both years. The prevalence of chronic LBP rose, with continued high levels of disability and care utilization. The increase in LBP care costs over the past two decades may be partly due to this rising prevalence. The study found that the prevalence of chronic LBP increased, with a significant rise in the proportion of individuals seeking care. The increase in prevalence was not due to increased care-seeking but rather to a higher number of people affected. The study also found that the prevalence of acute LBP increased slightly, but the greater increase in chronic LBP suggests a transition from acute to chronic cases. Possible factors contributing to the increase in chronic LBP include changes in demographics, ethnic differences, obesity, and psychosocial and physical work demands. The study also noted that increased depression rates may contribute to the rise in chronic LBP. The study's findings suggest that the increase in health care costs may be due to the rising prevalence of chronic LBP rather than increased care-seeking. The study's limitations include the cross-sectional design, which prevents firm conclusions on causality, and the lack of data on risk factors. The study's major strength is the use of similar methods and identical definitions of chronic LBP to examine trends over time. The findings highlight the need for strategies to address the increasing prevalence of chronic LBP and its associated costs.The prevalence of chronic low back pain (LBP) in North Carolina increased significantly from 3.9% in 1992 to 10.2% in 2006. This rise was observed across all age, gender, and racial groups. Despite similar symptom severity and general health, more people sought care in 2006 (84.0%) compared to 1992 (73.1%). The study used a cross-sectional telephone survey of North Carolina households, with identical definitions of chronic LBP for both years. The prevalence of chronic LBP rose, with continued high levels of disability and care utilization. The increase in LBP care costs over the past two decades may be partly due to this rising prevalence. The study found that the prevalence of chronic LBP increased, with a significant rise in the proportion of individuals seeking care. The increase in prevalence was not due to increased care-seeking but rather to a higher number of people affected. The study also found that the prevalence of acute LBP increased slightly, but the greater increase in chronic LBP suggests a transition from acute to chronic cases. Possible factors contributing to the increase in chronic LBP include changes in demographics, ethnic differences, obesity, and psychosocial and physical work demands. The study also noted that increased depression rates may contribute to the rise in chronic LBP. The study's findings suggest that the increase in health care costs may be due to the rising prevalence of chronic LBP rather than increased care-seeking. The study's limitations include the cross-sectional design, which prevents firm conclusions on causality, and the lack of data on risk factors. The study's major strength is the use of similar methods and identical definitions of chronic LBP to examine trends over time. The findings highlight the need for strategies to address the increasing prevalence of chronic LBP and its associated costs.