If you’re a back pain sufferer, you know exactly how costly your pain can be. Beyond the missed work days, doctors visits, and the expense of ongoing care and treatment, back pain can stop your life in its tracks. Try taking a walk, sitting at a desk, laughing, or even carrying on a conversation during an acute bout of back pain – it can feel almost impossible.
If you’re a chronic pain sufferer, you know your pain never leaves you – you consider your movements every time you stand up or sit down, while you sleep, and when choosing which activities to engage in.
The scary thing is, back pain is an epidemic. According to the American Chiropractic Association, as many as 31 million Americans are suffering back pain at any given time, and it’s estimated that 80% of the adult population will experience back pain at some point in their lives. This pain epidemic comes at a cost, and it’s a cost that’s largely preventable.
The Costs of Back Pain
The actual costs of back pain are very hard to estimate because there are so many factors that play into the real and associated costs – such as the cost to employers in missed work days, and, by extension, the loss of employee productivity. In fact, leading organizations can’t settle on a definitive dollar amount of the price of back pain, as estimates range from “at least $50 billion per year” (American Chiropractic Association), to $86 billion per year (WebMD), to more than $200 billion dollars per year (American Academy of Orthopaedic Surgeons).
Regardless of the exact amount, the cost is huge and significantly affects the average American. According to a study cited by WebMD, the average estimated annual medical expenditures for adults with back pain in 2005 was $6,096, while the estimated annual medical expenditures for those without pain was $3,516. That breaks down to a $2,580 greater annual medical expense for back pain sufferers, on average.
If there is a silver lining to the estimated average per-person cost, it’s that the actual per-person cost is variable, with roughly 10% of back pain sufferers picking up the tab on 80% of the total estimated annual costs. In other words, 90% of back pain sufferers seem to get by with moderate expenses – doctors visits, temporary prescriptions, and OTC care – while a minority of sufferers participate in expensive procedures and therapies that add up quickly.
Overall, back pain costs can be funneled into three categories: treatment costs, employer costs, and employee costs due to loss of wages and quality of life. While you might not immediately associate a loss in quality of life as a financial burden, it can be.
For instance, a day spent in bed is a day you can’t watch or play with your kids – this might mean extra money spent on childcare. Or, if you can’t run errands or wash your car, you might find yourself paying for a delivery service or a professional car wash. These expenses might seem negligible, but it can add up over time.
Treatment expenses are exactly what they sound like: the costs you undergo to treat your back pain. For some these expenses are low, including rest, over-the-counter pain relievers, and perhaps a trip to the doctor. For others, these expenses are astronomical, including long-term use of prescription painkillers and surgery.
The scary thing is, these expenses are growing every year. This is due in part to a steady increase in disability from musculoskeletal injuries, but it’s also because of the drastic increase in invasive treatments for back pain. According to Results Physiotherapy, from 1996 to 2004 the number of spinal fusions (a surgical procedure that essentially “welds” painful vertebrae together to prevent pain caused from movement) increased by 307%, the number of epidural steroid injections increased by 629%, and a correlation between the frequency of MRI and CT scans and subsequent surgeries was identified. In other words, as more advanced testing is used to diagnose back pain, the frequency of invasive procedures is increasing.
While in some cases invasive treatments are completely appropriate and may be the best course of action, more people are electing these expensive treatment protocols. There are lots of reasons why this may be the case – for instance, when someone has been in pain for long periods of time, surgery may seem like the only remaining option. In other circumstances, surgery may seem like a “quick fix” compared to ongoing therapy that may or may not help (this is shortsighted, as surgery requires ongoing therapy post-procedure). And some people may see surgery as a “jumping off point” – they’d rather start with the most drastic treatment to hopefully get to the desired result – no back pain – faster.
Finally, because surgery is becoming a more accepted option, there are some doctors and surgery centers that suggest surgery in order to pad their bottom line. This may be a completely unethical, but it happens. A 2011 Bloomberg article called out one such surgery center, Laser Spine Institute, for this method.
Regardless of why more expensive therapies are being elected, the truth is that less expensive therapies might suffice – and may even be more effective. Results Physiotherapy highlighted this point by citing a study of a change in treatment protocol at The Virginia Mason Hospital system in Washington State. When the hospital elected to use physical therapy for back pain treatment prior to using more specialized care (such as invasive surgery treatments), costs were reduced per back pain episode by 55%, fewer treatments overall were used (including medication, doctor’s visits and therapy sessions), and patients reported greater satisfaction with their total care. These statistics all indicate that physical therapy is a better option.
Furthermore, a study in the February 13, 2008 issue of the Journal of the American Medical Association found that the steady increase in treatment costs for back pain didn’t correspond with an improvement in patient outcomes. In other words, just because you spend more, it doesn’t mean you’ll feel better in the long run.
2. Missed Work & Employer Expenses
It’s not just the back pain sufferer who suffers when experiencing pain – the American workforce does too. Every year, back pain accounts for roughly 40% of all missed work days, and is the second-leading cause of missed work, lagging only behind the common cold and upper respiratory illnesses. According to the American Academy of Orthopaedic Surgeons (AAOS), in 2004, 25.9 million workers lost an average of 7.2 days of work due to back pain. That’s 186.7 million days of work lost. Employers pick up these costs in the form of loss of productivity of the employee (and perhaps of the entire team), insurance expenses, and perhaps Workers Comp, if the back pain was due to a workplace injury.
A 1999 study published in the American Journal of Public Health estimated that the direct cost of missed work days alone accounted for a $14 billion expense. With inflation (and not adjusting for an increase in median weekly wage), that’s about $20 billion in 2014. You can see how the total cost of missed work could damage the American economy.
And that just accounts for the loss of full work days – it doesn’t take into account the individuals who become limited in the work they do. AAOS cites that from 1999 to 2004, 62% of people who self-reported work or walking limitations stated that their limitation was due to lower back pain.
3. Short- or Long-Term Loss of Wages
Sadly, some individuals who experience back pain become temporarily or permanently disabled. While worker’s compensation or disability payments may help keep the injured party afloat while unable to work, these payments are unlikely to add up to the amount the individual could have earned had he or she remained healthy. Again, estimating the exact amount of lost wages is difficult, as many factors play a role in the amount a person can expect to pull in, including industry, education, and gender.
That said, the 2014 median weekly salary for full-time workers in 2014 is $791, with the median salary for women coming in at $716, and the median salary for men coming in at $867. In other words, an average year’s worth of lost wages due to disability is roughly $40,000. If the disabled individual can no longer hold a job that also provides benefits (such as health insurance), the loss in wages increases to account for the loss in benefits.
The total cost of back pain to the American economy – including treatment, employer expenses, and loss of wages – is in the tens to hundreds of billions, depending on the reporting agency, while the average cost to the back pain sufferer is more than $2,000 per year. That’s serious cash, and cash that could be better spent on other things if the pain were prevented.
Preventing Back Pain
While some back pain is unavoidable (for instance, an injury suffered during a car wreck), there are steps you can take to minimize your risk. Common risk factors for back pain include:
- Age (those over 40 are more likely to experience pain)
- Race (black women are more likely than white women to experience pain)
- Poor physical fitness
- Overweight or obesity
- Sedentary jobs
- Jobs that require extensive bending, lifting, and twisting
- Poor posture
While some risk factors can’t be avoided – there’s no stopping the aging process – it is possible to take care of your body and minimize your risk. If an instigating action didn’t cause your back pain (such as a car wreck or a bad fall), and if there’s no clear diagnostic disease that needs treatment (such as degenerative disc disease), chances are your back pain is due, at least in part, to controllable factors, such as being overweight, leading a sedentary life, or smoking.
When you take care of your whole health, your entire body benefits. I can attest that while my own back pain comes and goes, it’s more manageable when I prioritize healthy behaviors, including stretching, strength training (particularly of the core), and managing stress. In fact, when my own pain is at its worst, I’m usually overwhelmed by stress and fighting a depressive period. This isn’t unusual – depression and pain are closely linked. According to the Mayo Clinic, depression causes pain, and pain causes depression. Healthy behaviors that reduce anxiety, including partaking in regular exercise, can help you manage your depression and your pain.
Also, be aware that the simultaneous rise in overweight people and obesity and the rise in back pain isn’t coincidental. The AAOS states that Americans who are extremely obese have a four-fold increased risk of back pain, as continuously carrying around excess weight can wreak havoc on the bones and joints, leading to chronic pain. But the news isn’t all bad: The AAOS also went on to cite a 2013 study by the North American Spine Society that found that obese individuals who added just 20 minutes of light exercise each day were able to lower their risk of back pain by 32% – that’s certainly significant.
To minimize your risk of back pain, consider implementing the following strategies:
- Start Exercising. Focus on strengthening your core and lower back, while stretching your back, hamstrings and hip flexors. A strong back and limber body work together to help prevent back injuries from occurring.
- Lose Weight. Those extra pounds can do a number on your back and your other bones and joints. Talk to a trainer or nutritionist to take steps toward losing the excess weight a healthy way.
- Quit Smoking. Smoking affects the body’s ability to heal, while certain factors, such as a hacking smoker’s cough, can lead to back pain.
- Sit and Stand Up Straight. Focus on your posture while sitting and standing. When sitting, adjust your chair so your knees and hips are bent at a 90-degree angle, and sit with your feet flat on the floor, roughly hip-distance apart. Your back should be straight, your ears aligned with your shoulders and your hips. When you’re standing, you should focus on similar alignments: your feet hip-distance apart, your weight equally balanced between your legs, and your knees, hips, shoulders, and ear forming a straight line.
- Learn to Lift Correctly. Improper lifting contributes to a great number of back injuries. If you must lift or push heavy items, remember to “lift (and push) with your legs” with your core tight and your torso upright, rather than initiating the movement from your arms and back.
Even if you’re doing all the right things, you could still end up with back pain. Trust me, I understand. And while you should always see your doctor if severe pain was caused by a fall or injury, doesn’t improve with rest, is causing numbness or tingling, or is accompanied by other symptoms (such as fever), you may not need to rush to the doctor at the first sign of pain. Give yourself a few days to treat your pain at home – you might be surprised how well home remedies can work.
Even if the national cost of back pain is every-increasing, that doesn’t mean you can’t take steps to reduce your personal cost. By focusing on prevention and self-care, you can minimize your expenses.
Have you ever suffered from back pain? What was your experience?