LOWER BACK PAIN

LUMBAGO

Lower 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 those high-tech advances.

A general pessimism prevails, owing to the disabling nature of chronic lower 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.

Common causes of lower back pain are the lumbar facet joints and the sacro-iliac joints.

FROM THE COAL FACE

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!'

She will do her exercises faithfully, and come every two months for a treatment.

OPPORTUNISTIC COST

• 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 lower 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

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 of low back pain went to medical care, excluding imaging, whereas only 5% was allocated to chiropractic care in the treatment of Slipped Disk

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

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 lower back pain.

A not-uncommon, and less well understood cause of lower back pain is the Syndrome of Maigne.

Alternative Care for LBP saves Insurance Companies huge amounts.

• $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.

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)

Lower Back Pain and Leg Pain are often also associated with pregnancy. There are very many potential causes, with enormous economic consequences, associated with lower back pain and pregnancy.

Walking

Once over the acute phase of Lower Back Pain, a regular walk can make a huge difference. For more about how far, and how fast to walk, take this little test.

Return from Lower Back Pain to CONDITIONS

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