PainSci notes on Martin 2008:
Throwing money at spinal problems does not appear to helping Americans with back and neck pain, according to this report. Despite spending almost $86 billion in 2005, up 65% from 1995, disability was actually worse, rising from 21 to 26%.
The data was extracted from survey data from about 23,000 people per year, finding that they spent about $6000 annually, much more compared to about $3500 for those without neck or back pain — and of course the largest increase was in drug expenses, a dramatic jump of 400% . The opioid crisis was just getting started back then.
Although this data is now getting old, the trend of overmedicalization of neck and back pain has continued, if not accelerated. Virtually every “advanced” medical procedure and option for spinal pain is probably being overused.
This report was summarized more thoroughly by a New York Times article, Back Pain Spending Surge Shows No Benefit. As quoted there, Dr. Richard Deyo: “I do worry there is a combination of side effects and unnecessary treatments and labeling people as being fragile when they’re really not. The combination of those kinds of things may actually be in some cases doing more harm than good.” Perfectly said.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
CONTEXT: Back and neck problems are among the symptoms most commonly encountered in clinical practice. However, few studies have examined national trends in expenditures for back and neck problems or related these trends to health status measures.
OBJECTIVES: To estimate inpatient, outpatient, emergency department, and pharmacy expenditures related to back and neck problems in the United States from 1997 through 2005 and to examine associated trends in health status.
DESIGN AND SETTING: Age- and sex-adjusted analysis of the nationally representative Medical Expenditure Panel Survey (MEPS) from 1997 to 2005 using complex survey regression methods. The MEPS is a household survey of medical expenditures weighted to represent national estimates. Respondents were US adults > 17 years) who self-reported back and neck problems (referred to as "spine problems" based on MEPS descriptions and International Classification of Diseases, Ninth Revision, Clinical Modification definitions).
MAIN OUTCOME MEASURES: Spine-related expenditures for health services (inflation-adjusted); annual surveys of self-reported health status.
RESULTS: National estimates were based on annual samples of survey respondents with and without self-reported spine problems from 1997 through 2005. A total of 23 045 respondents were sampled in 1997, including 3139 who reported spine problems. In 2005, the sample included 22 258 respondents, including 3187 who reported spine problems. In 1997, the mean age- and sex-adjusted medical costs for respondents with spine problems was $4695 (95% confidence interval [CI], $4181-$5209), compared with $2731 (95% CI, $2557-$2904) among those without spine problems (inflation-adjusted to 2005 dollars). In 2005, the mean age-and sex- adjusted medical expenditure among respondents with spine problems was $6096 (95% CI, $5670-$6522), compared with $3516 (95% CI, $3266-$3765) among those without spine problems. Total estimated expenditures among respondents with spine problems increased 65% (adjusted for inflation) from 1997 to 2005, more rapidly than overall health expenditures. The estimated proportion of persons with back or neck problems who self-reported physical functioning limitations increased from 20.7% (95% CI, 19.9%-21.4%) to 24.7% (95% CI, 23.7%-25.6%) from 1997 to 2005. Age- and sex-adjusted self-reported measures of mental health, physical functioning, work or school limitations, and social limitations among adults with spine problems were worse in 2005 than in 1997.
CONCLUSIONS: In this survey population, self-reported back and neck problems accounted for a large proportion of health care expenditures. These spine-related expenditures have increased substantially from 1997 to 2005, without evidence of corresponding improvement in self-assessed health status.
Specifically regarding Martin 2008:
- “Back Pain Spending Surge Shows No Benefit,” Tara Parker-Pope, Well.blogs.NYTimes.com.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.
- Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness. Nakale 2018 Foot Ankle Int.
- No Added Benefit of Combining Dry Needling With Guideline-Based Physical Therapy When Managing Chronic Neck Pain: A Randomized Controlled Trial. Stieven 2020 J Orthop Sports Phys Ther.
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.