Back Pain And It's Effect on Economy
In USA 65 million Americans have experienced back pain at least one time. Chronic back pain is observed in 16 million adults in USA at a given time. Healthcare cost incurred for investigation, lab study, treatment and disability payment is close to 12 billion dollars every year. Loss of income for not being able to work is close to 50 billion dollars per year. Back pain influences inability to work and also results in higher healthcare cost.
Back pain in younger patient is caused by injury. Injury is caused by auto or work accident and domestic fall. In case of auto and work accident, cost of treatment is shared by auto insurance and workman's compensation. Personal private insurance or Medicaid assumes cost of treatment of young individual following domestic fall if patient is uninsured. Back pain is also common among elderly population. Back pain in older patient is mostly caused by degenerative diseases. Medicare pays cost of treatment of elderly patients. Increased spending by Auto insurance and Workman's Comp for treatment of back pain raises insurance premium. The increased cost is shifted to healthy individuals. Increased spending by Medicare and Medicaid for treatment of back pain is deducted from tax revenue.
Back Pain Effects on Work Productivity
Chronic back pain has major impact on work productivity. Decline in work productivity has been observed secondary to sick leave, restricted work, and secondary gain due to injury. Up to 90% of people experience an episode of back pain without other health concerns and these symptoms will decrease or disappear on their own within one or two months. During this period patient may be referred to several physician and may undergo several investigations. Young and elderly suffer with back pain, though the cause of back pain is different. Back pain in younger population is caused by sports injury, automobile accident and work accident. Young population studies have indicated chances of early improvement and better early recovery by staying active and avoiding more than a few days of relative bed rest. According to the NHS (National Health Service)-UK, back pain is the largest cause of work-related absenteeism in the United Kingdom. Although back pain may be painful and uncomfortable, it is not usually serious and is not a life threatening disease. Cost of treatment for back pain includes cost of investigation, physician fees, hospital cost, lab studies and legal fees.
Treatment of back pain includes medications, chiropractic treatment, physical therapy, acupuncture, interventional pain therapy and surgery. Apprehensive patient may see multiple physicians and may demand several investigations to identify the cause of pain to his satisfaction. Demanding patient with low pain tolerance may drive cost of investigation and treatment higher. While patient with tolerance to pain and suffering may delay the treatment or may even avoid seeing multiple physicians, which will result in lower cost of treatment. Most of the cause of back pain is treated for symptomatic relief. The most unpleasant symptoms, which results from back disease along with pain are tingling, numbness and weakness in lower leg. Symptoms of tingling, numbness and weakness causes apprehension and worries. Patient demands the relief of associated symptoms hoping he or she may be paralyzed and bed ridden for rest of the life. Wide range of treatment choice available for back pain often results in trial of multiple treatments in short period of time thus increasing cost of treatment. Epidural injection is performed with and without hyaluronidase medications. Addition of hyaluronidase with cortisone had increased cost of treatment but valued benefits were not observed.1
Spending for investigation and treatment of back pain is much higher when compared to other common diseases. The reason for higher expenses is probably addition of cost of multiple treatments, which is provided to patient simultaneously and repeated several time. This retrospective study by Hart OR suggest higher resource use for management of back pain.2
The single therapeutic beneficial treatment for low back pain is yet unknown though scientist and medical specialist have tried several conservative and invasive treatment. Insurance providers have expressed their concern about increased cost of treatment of back pain but avoided any research funding. American academy of pain medicine has expressed the concern of prevalence of chronic pain and annual cost in lost productivity. Patient and families have expressed the concern regarding loss of income and family hardship. The capital market drives on profit and loss. Profits are decreasing as salaries and bonuses have sky rocketed.
Medical equipment manufacturing companies, pharmaceutical industries and hospitals have increased the cost of their services and product. Insurance companies also want to increase profit by decreasing expenses. Expenses are shifted to patient by increasing co-pays and deductible. Insurance provider hopes patient will avoid or postpone the treatment. Insurance companies have created several layers for physician to get approval for lab or radiological studies and treatment.
Young male or female patients worry of back pain following auto, work or domestic accident. He or she is worried about loss of wages, job, how to pay for domestic expenses, co-pays, deductible and getting out of misery of back pain to go back to work. Physicians and hospitals are worried about how to get pre-authorization for investigations and treatment. Insurance companies are worried about increased cost of treatment and decreasing profit. Best outcome for young patient is to resume his work with no or less pain and for elderly patient is to continue with outdoor activities.
1. Epidural lysis of adhesions for failed back surgery and spinal stenosis: factors associated with treatment outcome.
Hsu E1, Atanelov L, Plunkett AR, Chai N, Chen Y, Cohen SP. Anesth Analg. 2014 Jan;118(1):215-24.
2. A study of National Health Service management of chronic osteoarthritis and low back pain.
Hart OR1, Uden RM2, McMullan JE3, Ritchie MS4, Williams TD5, Smith BH6.
Prim Health Care Res Dev. 2014 Mar 27:1-10.