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The Spine Blog

Friday, July 24, 2020

Assessing the societal cost of low back pain

The high societal cost of low back pain (LBP) has been well-documented over the years, though it is worthwhile to revisit this topic from time to time. In the United States, musculoskeletal conditions, including LBP, are the most  common cause of workers becoming disabled. In order to look at the societal costs of LBP in Spain, Drs. Alonso-Garcia and Sarria-Santamera used Spain's National Health Survey (NHS) of 2017 to calculate the prevalence of LBP, factors associated with LBP, and the direct (i.e. medical) and indirect (i.e. employment-related) costs associated with LBP. The NHS queried over 23,000 Spanish residents over age 14 and was designed to be extrapolated to the entire Spanish population. Approximately 50% of respondents were between 40 and 65 years old, with only 14% being under age 40. Overall, approximately 20% of respondents reported LBP in the past year. Female gender, age over 65, lower educational achievement (i.e. less than a high school degree), obesity, and a lack of physical activity were all associated with increased rates of LBP. Respondents reporting LBP had higher rates of physician visits, more emergency department visits, and more hospitalizations than those without LBP. Those with LBP also had more diagnostic tests, more PT visits, more psychologist visits, and more medication use compared to those without LBP. They calculated that LBP patients missed approximately 8 days of work and lost about 5 days of productivity at work due to LBP. They calculated a direct medical cost of 2.3 billion euro and an indirect employment-related cost of 6.7 billion euro, for a total societal cost of approximately 9 billion euro in 2017. This represents approximately 0.7% of Spanish GDP.

Papers like this always yield staggering numbers, and they serve as a good reminder about the social and economic costs of LBP. These analyses do not even consider the physical pain and psychological distress caused by LBP, which would add to the costs if quantified. While these studies only provide a rough-estimate of costs, they leave no doubt about the magnitude of the LBP problem. Unfortunately, little progress has been made in addressing LBP despite decades of study. The efficacy of surgery for conditions such as lumbar disk herniation and spinal stenosis has been demonstrated in the literature, however, these conditions represent a small minority of LBP cases. Axial LBP without radiculopathy or neurogenic claudication in the absence of spinal deformity is the most common type of LBP. Fortunately, most acute cases of LBP are self-limited and do not require much or any treatment. The most costly condition is chronic, axial LBP, which is generally refractory to any treatment. The underlying cause of chronic axial LBP is generally unknown, and likely involves both degenerative changes in the lumbar spine and psychosocial factors. While disability rates overall have been decreasing since the end of the great recession, musculoskeletal disability has remained high, with chronic LBP as the most common condition in this category. Given that chronic LBP is costing society as much as cardiovascular disease, diabetes, and cancer, research to address it should be getting funded at similar levels as the other conditions. Unfortunately, LBP is not a glamorous topic and receives minimal funding from national research institutions. Until that changes, we can anticipate more papers of this kind that highlight LBP's burden to society.

Please read this paper in the August 15 issue. Does this change you view the societal costs of LBP?

Adam Pearson, MD, MS
Associate Web Editor