Why might back pain decrease as we get older. Because by and large as we all get older, I mean almost all the joints in our body start aching, in the knees and the hips and I’m sure there are some people in the audience I know who can emphasize with me and I know that various parts of me hurt more and more each day. So why do we see decreased prevalence as people get older. And some of the things that have been suggested is that older people have cognitive impairment, they just forgot about the back pain; they are depressed, back pain becomes a minor issue in their lives when they’re depressed; they have comorbid conditions. It has been suggested that older people have increased pain tolerance; I don’t know if that’s true but that is certainly still written about. People get resigned to aging effects. I know my mother always says when I talk to her that I hurt all over and so she doesn’t ever think that she has back pain even though she has terrible scoliosis. And another issue is obviously the selective participation in studies, the healthiest older people who participate in studies. Overall it is probable that back pain is under-reported in the elderly.