LOW BACK PAIN

COST OF ILLNESS

Low back pain, it is freely admitted, is imposing a real, rapidly increasing and substantial economic burden on society, despite the technological advances in recent years. Perhaps because of the those high-tech advances.

A general pessimism prevails, owing to the disabling nature of chronic low back pain, the economics,and the great expense to the patient, the insurer, and the loss of productivity in their place of work.

Medicine and chiropractic alike would acknowledge that chronic lumbago is clinically challenging, even to the most experienced doctor: whilst under care, the unexpected can radically change the outcome of treatment: one sneeze, one journey to the funeral of a beloved, or one stumble while taking a walk can all play havoc.

The economic burden of a disease is the sum of all costs associated with that condition which would not otherwise be incurred if that disease did not exist.

FROM THE COAL FACE

Mrs S. consulted me yesterday, and my secretary was soon cursing. I started running late. Why?

Mrs S. is an elderly lady. She could barely walk two months ago when she first consulted me, so bad was the pain in her groin and her lumbar region. Actually sacro-iliac pain, but never mind.

'Doctor, I have to stop treatment, I'm afraid.'

'Oh, why?' That's me speaking.

'I just can't afford your fees any more.'

'I can understand. You're not the first. But how are you doing?'

'Oh, I am so much better. I can walk again, and I can sleep on that hip now. I really want to thank you. I don't want to appear ungrateful, but this will be my last consultation.'

The fact of the matter is that health care is expensive. And my fees are amongst the lowest in town. Mrs S and I came to a compromise. She is 1000% better, but I know if we completely stop treatment, it won't be too many months before she slowly slides back to where she was. As they say: Old age is a bugger, and then you die!'

OPPORTUNISTIC COST

Economic costs related to low back pain are extremely difficult to measure. For example, the so-called OPPORTUNITY cost is that value which corresponds best to the alternative use of resources:

Would the economic saving by avoiding expensive surgery, and using more conservative means actually provide in the long term a lower sum of total costs?

Would the savings associated with sending a patient with low back pain back to the work place too soon, with the attendant risk of relapse, be greater or less than the acknowledged increasing risk of allowing the patient to remain too long away from work?

ECONOMIC BURDEN

What then is this total cost of lumbago — or the economic burden? Economists point to three components:

(1) DIRECT COSTS

Low back pain economics would include the services of medical doctors and complementary practitioners such as chiropractors, medication, hospitals, scans etc. These are relatively easy to estimate, but it would also include the cost of travel to the doctor and even renovations to their home to make it more accessible to a person disabled by chronic LBP.

Economic surveys of 10 countries found that 65% of direct costs went to medical care, excluding imaging, whereas only 5% was allocated to chiropractic care in the treatment of LBP.

(2) INDIRECT COSTS

Lumbago causes loss of productivity due to sick leave, ‘absenteeism’ and decreased presence due to so-call ‘presenteeism’ is staggeringly large in economics, and is where chiropractic really comes into its own: numerous Workman’s Compensation studies conclude that chiropractors get their patients back on the job sooner.

Lost earnings, early retirement and replacement of vital employees – called ‘friction’ cost are included in indirect costs of economics. It would also include the need to hire help both in the home and to do routine maintenance around the house, not done due to low back pain.

Lost productivity costs due to low back pain was estimated at $16.9 billion in a 2006 US economics study. (Spine 31)

(3) INTANGIBLE COSTS

Economic costs should also reflect the value of decreased enjoyment of life because of illness. However, these costs are rarely included when estimating the economic burden of an illness because of general societal discomfort with placing a monetary value on these aspects of a disease.

BACK TO WORK

Numerous studies related to LBP suggest that the greatest economic cost savings (from a societal perspective) may be obtained by early return to work, minimizing lost productivity.

Further studies point that overall this is also to the patient’s benefit, and not only the employer and the health insurer.

Furthermore, exercise, rehabilitation and fear avoidance training are all considered vital in achieving a good end result in the care of the patient suffering from low back pain.

Alternative Care for LBP saves Insurance Companies huge amounts.

A 2005 study of 109,080 patients suffering from LBP clearly showed that inclusion of Chiropractic resulted in significant economic savings for two insurance companies:

$342 per patient for those consulting (mainly) chiropractors –vs- $506 for those consulting medical doctors (and this excluded surgical and hospital care). Spine 30(12)..

Rehabilitation in Low Back Pain.

Low back pain patients gave an interesting insight in research done in Norway. Over 82% of patients with LBP are more than satisfied in the short term with chiropractic management.

However, in the long term, this percentage dropped indicating that more emphasis should be placed by chiropractors into rehabilitation and continuing care to prevent re-occurrence of lumbago. (JMPT 28)

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