Low Back Pain: The Problem

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20 minutes

Acute back pain is usually a self limiting problem that is managed appropriately and should resolve spontaneously. The majority (approximately 95% of cases) of acute low back pain is non specific and serious conditions are rare causes of acute low back pain ([1], [2], [3]). Recent research has suggested that the longer an individual is disabled by back pain, the less chance he or she has of  returning to work and the more health care cost he or she will require. For instance, if an individual has been off sick with back pain for 1 month, there is a 20% chance of them still being off work one year later and for 6 months, there is a 50% chance of them being off work one year later [4]. This situation is slowly changing, and with appropriate interventions, Waddell in the later edition of his textbook has shown that this situation may be modified. After 2 years with low back pain, patients do not tend to return to work and consume a large amount of NHS resources. Therefore, the longer patients are on the waiting lists, the more chance they have of becoming chronic and there are major cost implications in terms of human suffering, social and NHS resources. Low back pain is estimated to affect at least 60% to 80% of the population at some time in their lives [5] and most of these patients will have resolution of their back pain with simple measures including simple analgesia, manipulation and exercise advice. However, the major part of the cost of back pain, estimated to be £500 million annually to the National Health Service in the UK is from the small proportion of persons with low back pain whose symptoms become chronic [5]. The importance of good assessment and timely, evidence based management cannot be underestimated because of the costs of back pain to the individual, his or her family and society. The figure below illustrates the cost of back pain to the NHS.

Back pain and the NHS

 

In the UK, 2.5 million people have back pain every day of the year [6] and results in a total cost of £12.3 billion (22% of UK healthcare expenditure). Management of chronic pain patients in primary care in the UK accounts for 4.6 million appointments per year, equivalent to 793 whole time GPs, at a total cost of around £69 million [7]. In the UK, back problems are the leading cause of disability with nearly 119 million days a year lost: one in eight unemployed people give back pain as the reason they are not working [6]. Half of the total days lost due to back pain are due to the 85% of people who are off work for short periods of less than seven days, and half by the 15% of people who are off work for more than one month.

Duration of work loss with back pain

The estimated cost to the NHS is £481 million a year (min-max range £356 - 649 million), with non NHS costs (such as private consultations and prescriptions) being an additional £197 million. Costs of Department of Work and Pension benefits is estimated at about £1.4 billion with lost production estimated at £3.8 billion. This breaks down to an annual NHS cost to a purchasing authority of 250,000 people of £2.2 million (range £1.6 - £2.9 million). A typical GP practice with five GPs and 10,000 patients would bear costs of about £88,000 (range £65,000 - £118,000) [8].

This word cloud illustrates Srangers et al [9] data and shows the impact a number of chronic conditions have on quality of life with musculoskeletal conditions having the greatest. The larger the word, the more impact

For a good review of the quality of life issues in musculoskeletal pain, consult Tuzun 2007 [10].


References

  1. Waddell, G., 2004. The back pain revolution, 2ndnd ed. Churchill Livingstone, Edinburgh.
  2. , 2003.
  3. Sprangers, M.A.G., al, et, 2000. Which chronic conditions are associated with a better or poorer quality of life?. Journal of Clinical Epidemiology, Journal of Clinical Epidemiology 53, 895-907.
  4. Tüzün, E.H., 2007. Quality of life in chronic musculoskeletal pain.. Best Pract Res Clin Rheumatol, Best Pract Res Clin Rheumatol 21, 567-79.
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