Published 1/1/2009

Aching backs impact cost, disability

USBJD project draws attention to burden of musculoskeletal conditions

Low back and neck pain are among the most common physical conditions requiring medical care. They also greatly affect the ability to work and manage daily activities of life. Each year one in two persons will experience back pain severe enough to make him or her aware of it. One in five will experience back pain severe enough to limit the amount or type of work he or she can do, with one in 20 unable to work at all. One in seven persons will spend at least one half day in bed due to back pain. For many, the pain will last only a few days or weeks. However, chronic back pain of months to years often results.

According to two national health surveys, close to 30 percent of the adult population in the United States reported experiencing low back pain. It is also the most common physical condition for which patients visit their doctor. In 2004, 15 percent of the U.S. population visited a physician with a complaint of back pain, a steadily rising rate since 1998 (Fig. 1). Overall, 40.5 million persons sought medical treatment for low back pain in 2004; 4 percent of patients required hospitalization.

Neck pain is reported by 15 per­cent to 21 percent of adults in the two studies. Although less common than low back pain, neck pain was the cause of 16.4 million patient visits in 2004. As with low back pain, most patient visits were to a doctor’s office, but 3 percent of patients required hospitalization.

The cost of back pain
In 2004, the estimated annual direct cost of treating back pain was $193.9 billion. Between 1996 and 2004, the cost of spine conditions, in 2004 dollars, increased by 49 percent. The largest share of increase was related to prescription medications. In addition, annual indirect costs for lost wages resulting from back pain were estimated to add another $22.4 billion to this cost.

Equally costly is the impact of back pain on the quality of people’s lives. Back pain is the most frequently identified cause of limitations in ability to work or walk. Between 1999 and 2004, an average of 62 percent of persons reporting work or walking limitations reported low back pain as a cause. Neck pain was the second most frequently cited cause.

In 2004, 25.9 million persons lost an average of 7.2 days of work due to back pain—a total of 186.7 million work days lost that year.

Spinal procedures to treat back pain
Although nonsurgical treatment for back pain is the treatment of choice, when back pain becomes so disabling that patients can no longer function in the activities of daily living, spine surgery may be performed. The three procedures most commonly performed are spinal diskectomy, spinal fusion, and spinal decompression.

The number of spinal fusion procedures performed annually has increased steadily since 1998 (Fig. 2). The cost of performing spinal fusions in 2004 was estimated to be $17.6 billion, more than three times the total cost in 1998. A diskectomy is performed primarily on patients with a ruptured disk. About 300,000 procedures are performed each year. In 2004, the total health care cost associated with diskectomy procedures was estimated to be $11.25 billion. More than one half (53 percent) of patients were between the ages of 45 and 64.

The future
Greater understanding of the causes of back pain and its resultant disability is needed to halt the rising trend. Understanding why disk degeneration causes pain in some while not in others is needed to address both the burden of pain and the disability it causes.