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Health Care Costs and Opioid Use Associated With High-impact Chronic Spinal Pain in the United States

Herman, Patricia M. ND, PhD; Broten, Nicholas MS; Lavelle, Tara A. PhD∗,†; Sorbero, Melony E. PhD; Coulter, Ian D. PhD

doi: 10.1097/BRS.0000000000003033

Study Design. A descriptive analysis of secondary data.

Objective. The aim of this study was to estimate health care costs and opioid use for those with high-impact chronic spinal (back and neck) pain.

Summary of Background Data. The US National Pain Strategy introduced a focus on high-impact chronic pain—that is, chronic pain associated with work, social, and self-care restrictions. Chronic neck and low-back pain are common, costly, and associated with long-term opioid use. Although chronic pain is not homogenous, most estimates of its costs are averages that ignore severity (impact).

Methods. We used 2003 to 2015 Medical Expenditures Panel Survey (MEPS) data to identify individuals with chronic spinal pain, their health care expenditures, and use of opioids. We developed prediction models to identify those with high- versus moderate- and low-impact chronic spinal pain based on the variables available in MEPS.

Results. We found that overall and spine-related health care costs, and the use and dosage of opioids increased significantly with chronic pain impact levels. Overall and spine-related annual per person health care costs for those with high-impact chronic pain ($14,661 SE: $814; and $5979 SE: $471, respectively) were more than double that of those with low-impact, but still clinically significant, chronic pain ($6371 SE: $557; and $2300 SE: $328). Those with high-impact chronic spinal pain also use spine-related opioids at a rate almost four times that of those with low-impact pain (48.4% vs. 12.4%), and on average use over five times the morphine equivalent daily dose (MEDD) in mg (15.3 SE: 1.4 vs. 2.7 SE: 0.6). Opioid use and dosing increased significantly across years, but the increase in inflation-adjusted health care costs was not statistically significant.

Conclusion. Although most studies of chronic spinal pain do not differentiate participants by the impact of their chronic pain, these estimates highlight the importance of identifying chronic pain levels and focusing on those with high-impact chronic pain.

Level of Evidence: 3

Our analysis of 2003 to 2015 data from the Medical Expenditures Panel Survey found that overall and spine-related health care costs were more than double, and opioid usage was four times higher in those with high-impact chronic spinal pain than those with low-impact, but still clinically significant, chronic pain.

RAND Health, RAND Corporation, Santa Monica, CA

Center for the Evaluation of Value and Risk in Health, Institute of Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA

RAND Corporation, Pittsburgh, PA.

Address correspondence and reprint requests to Patricia M. Herman, ND, PhD, RAND Corporation, Santa Monica, CA 90401; E-mail:

Received 15 November, 2018

Revised 13 February, 2019

Accepted 25 February, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

This work was conducted as part of a larger project on the appropriateness of spinal mobilization and manipulation for chronic back pain and chronic neck pain funded by National Center for Complementary and Integrative Health, National Institutes of Health, Grant No. 1U19AT007912-01.

Relevant financial activities outside the submitted work: grants.

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