Back pain isn’t glamorous or sexy. Because the mortality is minimal, it doesn’t grab our attention the way that cancer or AIDS or heart disease do. But the economic impact is astounding and worthy of our attention, both as potential patients (4 out of 5 Americans are affected at some point in their lives) and as voters concerned with policy that directs allocation of limited health care dollars. A recent article that appeared in the medical literature (Luo X, Pietrobon R, Sun S, Liu G, Hey L. Estimates and Patterns of Direct Health Care Expenditures Among Individuals with Back Pain in the United States. Spine. 2003; vol. 29, no. 1:79-86) conservatively estimated that $91 billion was spent on health care for back pain in 1998 (the most recent data available) – making it one of the most costly diseases affecting the US population.
The real drama isn’t the magnitude of that figure, but the fact that prevention and early intervention are quite often effective in preventing disability from back pain – which means that much of the expenditure might be avoidable, as the study demonstrated that duration of disability is associated with higher cost. We've made great strides in cost containment over the past 25 years, with a switch to outpatient care for most cases; the Luo et al article discovered that inpatient costs accounted for less than one-fifth of the back pain costs in 1998, compared to 40% in 1977. However, the average cost is still 60% higher per capita vs. the cost of treating non-back pain patients, and only 10% of that cost is due to back surgery. New technologies and techniques proven to provide relief and restore function have added to the cost, but education and screening could go a lot further to reduce not only the expense, but the pain and suffering of the approximately 26 million Americans who are treated for back pain every year.
Government funding (through Medicare) sets the tone for health care reimbursement practices in this country, and we need to look at a policy-making level at how our health care dollars are being allocated to back pain – not just in treatment, but prevention and research into its causes and most effective therapies. Spine care physicians continue to research treatment options with the best patient outcomes and cost-effectiveness factored in, but a paradigm shift is needed to focus attention on prevention and early intervention. Some measure of control on prescription drug prices would also help stem the rising tide of back pain expenditures.
Disc problems (primarily herniation and degeneration) and spondylolysis (stress fracture of the vertebra) lead the back pain diagnoses in cost of treatment. The North American Spine Society (NASS) has been trying to raise awareness of these problems with its annual Spine Health campaign targeted at patient education. The article by Luo et al reinforces the message that back pain imposes a heavy burden not only on the national economy, but in the human cost of suffering, decreased quality of life and lost productivity. Why not take a proactive step and assess your own spine health? Are you aware of the load your spine bears on a daily basis? Do you know what happens as your spine ages, or the toll you impose on it if you are a smoker or overweight? The NASS Web site at www.spine.org has a section “For Spine Patients” where you can get to “Know Your Back!” or learn some “Exercises for a Healthy Back”. If you’ve been diagnosed with disc problems or spondylolysis, the NASS Web site provides easy-to-understand explanations of your condition and outlines the treatment options and long-term prognosis. If you have some back pain or are at risk due to occupational hazards or family history, you can take the first step by finding a spine care specialist through “Find a Spine Doctor”. If you don’t have Internet access, a toll-free call to NASS at (866) 960-6277 will get you free copies of this information and the name of spine care specialists in your area. An ounce of prevention and early intervention today could be worth $91 billion in cures!