Medicine for Low Back Pain - What's the Bang for Your Buck?

Photo: Christy Thompson

A recent study published in the Journal of the American Medical Association comparing the amount of money spent on back pain to patients’ health gains shows that medicine is not a great bang for the buck, so to speak. According to the authors, back pain accounts for 2% of all visits to the doctor, trumped only by routine exams, diabetes and hypertension. So, researchers wanted to know the value received for the money spent on behalf of patients who experience back pain.

The researchers looked at expense data for US hospitals, clinics, emergency departments and drug store pharmacies to find the amount of money paid out between 1997 and 2005. They also surveyed approximately 22,500 people with and without low back pain in 1997, and again in 2005. Of those surveyed, approximately 3150 in each year had low back pain. And, the researchers took a close look at another survey that had already been done during 2000-2005. They used the combined set of surveys to look at patients’ functional ability with walking, bathing, eating, bending and lifting, social life, work, and more.

Statistical analysis of the data collected revealed that although medical costs for back pain rose 65% between 1997 and 2005, patients felt 20% worse. They also found that per patient costs for those with low back pain were 73% more than those for patients without spine pain. There was only a “modest increase” in the number of spine patients during the 8 years the study was conducted.

The reason? In the study, the authors note two things of interest: First, the largest relative increase went to medications. The authors suggest that new pain medications, which are expensive, may be at the root of the increase. The same may be true for the wide use of diagnostic imaging tests and other similar tests, injections, higher expectations on the part of patients, more spinal fusion surgery and the achievement of only the lower limits of standards of care on the part of providers. Second, the authors note an increase in health problems accompanying the back pain (called a comorbid condition), which may have been treated at the same time as the back problems, but were billed in addition to them.