Researchers Need to Investigate Costs Associated with Low Back Pain

Health care, like most other things in life, has a cost attached to it. For people with low back pain, this cost can be significant. According to a recent study in the United States, costs from low back pain had increased from 52 billion dollars to 102 billion dollars - doubling in only seven years. If there were more people with back pain, this could be understandable, but the number of people experiencing low back pain has not doubled as the cost has. The costs are the result not only of direct treatment, but lost work and early retirement. This can add up to 85 percent of overall costs.

One issue that adds to the cost of caring for low back pain is the large number of choices a patient has. Someone with back pain may choose to be treated with traditional medicine, while others may try chiropractors, physical therapy or various types of complementary and alternative medicines (CAM). Interestingly, given the many choices for care, there are some who suggest that cost-effectiveness may be a better way of choosing treatment than clinical effectiveness (how effectively the pain is relieved).

The authors of this study wanted to look at methods and results of cost utility analyses by looking at clinical trials and studies of low back pain treatments. To do this, researchers searched through medical literature to find these studies, looking for studies that involved adults, two or more types of treatment for lower back pain, reports of the costs, and reports of utility. In all, they found 15 studies, most of which had been published in the previous three years, that met all of their criteria.

The results showed that most studies were done in the United Kingdom, involved lower back pain and lasted for at least one year. The most common intervention was education, follwed by exercise therapy, spinal manipulation, surgery and then "usual care" from a general physician. Patients who underwent naturopathic care had fewer spinal manipulations and physical therapy, as well as fewer pain medications. The patients who were followed for usual care did receive more spinal manipulations.

The cost of the treatments varied tremendously, from only 304 dollars per year to 579,527 dollars per year, with 13,015 dollars being the median amount.

The authors were disappointed at the lack of studies done to understand the cost related to low back pain, as well as the quality of the studies done. They feel that this is an important issue that needs addressing in order to help patients return to work and to keep health care costs under control. The studies that were included in this research compared everything from one type of surgery to another, to education and exercise to care from a general physician. Because the goals were so varied, it really wasn't possible to come with a firm conclusion regarding costs related to low back pain. The authors suggest that researchers be educated regarding the importance of studying the same sorts of things so that findings can be compared fairly and properly.

Simon Dagenais, DC, PhD, et al. Can cost utility evalutions inform decision making about interventions for low back pain? In The Spine Journal. No. 9. Pp. 944 to 957.

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