If you have never been laid out because of back pain, consider yourself lucky. After all, 80 to 90% of all adults in the U.S. will experience back pain in their lifetime. Not only is the physical pain real and sometimes debilitating, the other impacts of back pain are just as real and can be equally debilitating. From the economy to the cost of healthcare, here are the ways that back pain impacts our lives.
First, some basic statistics on the incidence of back pain in the U.S.:
- According to a report in 2010 by the Centers for Disease Control and Prevention’s Center for Health Statistics, low back pain is the leading cause of pain for people in the U.S.
- Over six million people in the U.S. are being treated for chronic back pain (that is pain lasting for longer than three months that is unresponsive to treatment).
- Back pain is one of the most common reasons that people miss work and is the second leading reason for doctor visits (behind respiratory illness).
- Fifty percent of U.S. workers say they experience back pain every year.
Beyond the impact of the sheer number of people who suffer from back pain every year, the burden on the healthcare system is enormous. A study by researchers at the Duke University Medical Center found that patients with back pain spend $90 billion a year on medical expenses, with over $26 billion of that total spent directly on back pain-related medical care. Lead researcher Xuemei Luo, Ph.D. had this to say about that finding:
“To put these expenses in perspective, the total $90 billion spent in 1998 represented 1 percent of the U.S. Gross Domestic Product (GDP), and the $26 billion in direct back pain costs accounted for 2.5 percent of all health care expenditures for that year. We believe that the results of our analysis highlight the prevalence of back pain in the U.S. and its impact on the health-care system. Not only are the costs enormous, but they vary widely across patients with different clinical, socioeconomic and demographic backgrounds.”
The study went on to outline the differences in expenditures across different categories of care between those with back pain and those without back pain:
- Inpatient charges: $1,075 vs. $774
- Office visits: $910 vs. $425
- Prescription drugs: $541 vs. $340
- Outpatient care: $460 vs. $248
- Home health $105 vs. $92
- Emergency room: $102 vs. $61
In some cases, expenditures were nearly double for those suffering from back pain.
Beyond healthcare, the economic impact of back pain is enormous, costing more than coronary artery disease and the combined costs of rheumatoid disease, respiratory infection, stroke, and diabetes. This economic impact includes both direct and indirect costs. Direct costs include medical expenses such as those listed above, but indirect costs can be harder to measure. These include things like lost wages, lost productivity, cost of disability payments, lost tax revenues, and other benefits of a healthy, wage-earning workforce.
While specific figures are difficult to come by in the United States, a review of available data in the Medline database found the following indirect costs associated with back pain between 1996 and 2001:
- Workers missed 149 million days of work due to low back pain alone, as compared to 101 million days missed due to work-related injury.
- Chronic low back pain cost approximately $1,230 for each man and $773 for each woman in lost work days, with an annual loss of productivity total of $28 billion.
- The reported average number of days of work disability due to back pain ranges, from 75 for the first incidence to 337 days of total compensated missed work days.
While the economic impact of back pain can be as much as 1.5% of a country’s gross domestic product (GDP), the personal economics of back pain are also affected. People on disability have a much higher chance of lowered socioeconomic status, and poverty or severely decreased income is closely correlated with many negative health outcomes. Simply put, this means that a person whose income is affected by back pain is more likely to be more negatively affected by back pain.
A research task force organized by the National Institute of Health’s Pain Consortium recognizes these impacts of back pain and is calling for more organized standards of research so that faster progress towards more effective treatments may be seen. The task force co-chairs are Drs. Richard A. Deyo of Oregon Health and Science University, Portland; and Samuel F. Dworkin of University of Washington, Seattle. They found that the main issue of back pain research, specifically for chronic low back pain (cLBP), is that researchers use different definitions with a scattered focus, resulting in slow progress towards common, effective treatment.
The task force chairs propose setting up a structure for research that streamlines the process while maintaining rigorous, focused standards, as follows:
- Start with a clear definition: The task force recommends that the clear, standard definition of chronic back pain is pain that lasts for longer than three months, with pain occurring on at least 50% of the days for six months.
- Focus on the impact: Studies should use an impact score to focus on how daily life is affected by back pain, including intensity of pain, ability to function, and interference with daily life.
- Specify a minimum dataset: The task force believes that certain types of data need to be collected for a study to be reliable. This includes contributing factors, any previous attempts at treatment, and claims of workers’ compensation.
- Clarify outcomes: Although the task force was not able to craft a standard definition of what a clinically significant change might consist of in research studies, they attempted to come up with the most important outcomes of each study.
The task force also believes that future areas of study should focus on the study of new combined outcome measures as well as evaluating and improving minimum datasets.
With so much at stake, economically and socially, what further areas of study would you like to see for back pain research?
Image by Pictures of Money via Flickr