If you have back pain, you are in the majority. Estimates vary, but approximately 60% to 80% of us will get at least mild back pain at some time in our lives. In 2007 alone, about 27 million US adults aged 18 or older (11% of the total adult population) reported having back pain, according to the Agency for Healthcare Research and Quality. About 70% of these people -- 19.1 million -- sought treatment by a doctor, the agency says. It also says that more women (10.9 million) received medical treatment for their back pain than did men (8.2 million).
Intensity levels of back pain may range from simple muscle and posture-related pain to life-altering and potentially fatal injuries affecting the spinal cord. The good news is that most of the time, back pain can be successfully (either partially or wholly) addressed with exercise, conservative treatment, and alternative therapies.
Who Gets Spine Problems?
Back pain may occur at almost any time during the life cycle. Studies show that children are at risk, workers are at risk, and active people between the ages of 35 and 55 are at risk. Seniors and elderly people have a disproportionately higher risk for falls, which can result in debilitating neck fractures. Research also shows that genetics may play a role in disc degeneration, which often causes pain.
Although there’s no definitive profile for an individual with back problems, a 2008 survey reported in the Journal of the American Medical Association reported higher rates of spine problems among white women with public insurance. The individuals in this group also showed a greater tendency toward at least a short period of unemployment, being older, and being married or in a committed relationship.
Back Pain Is Expensive
Back pain is one of the most expensive health problems, although sources vary as to where it ranks in relation to other common conditions such as heart disease, stroke, cancer, diabetes and arthritis.
According to the AHRQ, in 2007 a total of $30.3 billion was paid to providers, such as doctors, physical therapists and others, as well as to pharmacies. The Journal of the American Medical Association reports that spine care costs reached $85.9 billion in 2005.
But spine treatment is a part of a $2.2 trillion healthcare industry. Although costs were high (exorbitant, in my opinion), the AHRQ reports they represented only 3% of total medical expenditures in the US in 2007. The Journal of The American Medical Association says that low back pain (alone) accounted for 2% of all doctor visits in 2005.
But How Much Does Back Treatment Cost Real People Like You?
The 2008 survey reported by the Journal of the American Medical Association mentioned above asked approximately 23,000 people with and without spine problems about how much their medical costs were. The researchers found that on average, people with back or neck problems spent about $6090 in 2005, while their spine healthy counterparts averaged $3056 the same year. The AHRQ reports that on an individual basis in 2007, costs for spine treatment averaged about $1500-$1600 per person.
Most of the time, the AHRQ says, fees for office visits and medications combined were paid by private insurance (45.2%). But Medicare kicked in 23% and you, the health consumer, paid about 16.8% of your treatment costs in the form of out-of-pocket expenses.
Also, Americans spent approximately $7 billion from their own pockets on alternative medicine for back treatment in 2007. Note: I arrived at this number by calculating percentages of total costs ($33.9 billion) spent on CAM for back pain (17.1%) and neck pain (5.9%), based on information provided by the National Center for Complementary and Alternative Medicine’s website (NCCAM).
Lots of Treatment, But Where Is The Relief?
Perhaps even more disturbing than the high cost of care is the fact that treatment costs have been on the rise for many years without a corresponding improvement in the quality of life for health consumers.
According to the AHRQ, collective costs for back pain have more than doubled since 2004, and the Journal of the American Medical Association survey found that total expenditures for neck and back care increased by a whopping 65% between 1997 and 2005. Although back care costs rose more rapidly than the overall rise in health care costs for the same time period (with only a modest increase in the number of people seeking treatment for their back pain), the survey found no “appreciable” health improvements in the respondents. (The researchers asked respondents to rate their own health status, and posed questions about disability, functioning, work limitation and social roles.)
So where did the extra money go? Medication tops the list, followed by office visits. The researchers suggest that “wider use of new drugs may account for some of this increase.” The new drugs include gabapentin, fentanyl, and time-release oxycodone. The researchers also note that after 2003, when COX-2 inhibitors were taken off the market, use of narcotic pain medication for spinal pain increased.
Martin, B., Deyo, RA, et. al. Original Contribution Expenditures and Health Status Among Adults With Back and Neck Problems JAMA. 2008;299(6):656-664.doi:10.1001/jama.299.6.656 http://jama.ama-assn.org/content/299/6/656.full
National Center for Complementary and Alternative Medicine. The Use of Complementary and Alternative Medicine in the United States: Cost Data. NCCAM website. Accessed: Jan 2, 2012. http://nccam.nih.gov/news/camstats/costs/costdatafs.htm#overall
Soni, A. PhD. Back Problems: Use and Expenditures for the U.S. Adult Populations, 2007. Statistical Brief #289. Medical Expenditure Panel Survey. Agency for Healthcare Research and Quality. July 2010. http://www.meps.ahrq.gov/mepsweb/data_files/publications/st289/stat289.pdf