Business of Well-being

Innovating Low Back Pain Management in the Workplace

American workers are no stranger to low back pain (LBP). Over 80 percent of Americans experience at least one episode of LBP over the course of their lives, and nearly 1 in 4 workers report LBP--making it a top reason to seek primary care.

The nationwide cost for treatment and management of LBP continues to climb upwards of $100 billion annually, with two-thirds of this cost being the result of lost wages and reduced productivity. Employers bear much of this burden.

Accounting for productivity loss as well as medical expenses, the total cost to employers for back pain amounts to $51,400 per 100 employees annually. Despite significant advances in pharmaceuticals, injections, and spinal surgeries, LBP is still on the rise, and health insurance costs for its treatment continue to increase.

Because low back pain often appears with other symptoms, such as depression and chronic fatigue, the costs for employees and employers are multifaceted, impacting both personal and professional life.

So how can we better treat low back pain and improve its deleterious effects on workplace health and wellbeing? The short of it:  Primary care doctors need more training in pain management, and greater collaboration with diverse specialists, including physical therapists, chiropractors, acupuncturists, behavioral health providers, and health coaches.

Traditional treatments for low back pain include diagnostic imaging, spinal injections, and surgeries. As a team of physical medicine experts with specialized training in pain science, we see that significant lasting improvement in low back pain comes from comprehensive, integrated care plans for patients.

Research shows that traditional methods like MRI imaging do not add significant value to the diagnostic and treatment process, and can, in fact, create circumstances for lower-value, higher risk treatment at higher costs. One study in Health Service Research found that patients were initially prescribed advanced imaging over physical therapy for LBP management both paid more and had a higher likelihood for complex treatments, including spinal surgeries, injections, fusions and opioid medications.

This increased rate can be attributed to a number of factors--from financial incentives and relationships with device companies to a larger aging population, and advancements in surgical techniques and fusions being more easily achieved. The sheer volume of MRI imaging, subsequent injection and surgical procedures has increased the risk of unnecessary surgery.

Higher spending in healthcare has grown typical alongside higher rates of surgery, which account for a significant proportion of all LBP-related expenses. Over the course of a decade, hospital spending for spinal injections increased by more than 500%, from $75 million to $482 million. Despite increased surgical procedures, prescription painkillers, and medical spending, research has been mixed when it comes to successful patient outcomes.

In fact, it remains possible for disability and pain to continue post-surgery. A 2011 study compared workers' compensation in patients who received treatment for lower back pain in the form of either spinal fusion surgery or non-surgical treatment like exercise and physical therapy, and found that patients who did not have surgery went back to work sooner--within two years of injury--and were less likely to continue taking opioid medications.

While there is no question that some patients require more complex treatment methods, such as fusions for highly painful and unstable lumbar segments, a significant portion of patients undergo surgical procedures that are not warranted and have the potential to do more harm than good for long-term patient outcomes.

A 2015 study in Acta Neurochirurgica found that repeated fusions yielded poor results for patient pain management and not only recommended careful consideration as a preventative measure against future "unnecessary" spinal fusions, but promoted alternative nonsurgical methods.

Research study after research study reveals the exorbitant costs of care and that the current standards of treatment are not the most effective options for LBP. As a result, the American College of Physicians and American Pain Society strongly recommends that the initial and costly MRI approach to low back pain should be taken only when significant neurological signs and risk of cancer are present.

Behavioral therapy, chiropractic, physical therapy, exercise, and acupuncture are promoted by the CDC as cost-effective, results-driven solutions to pain management that have the potential to ameliorate chronic pain. The Alliance for Health Policy came to a similar conclusion in September 2017 during a briefing on the intersection of physical and behavioral health in chronic pain management.

Their expert medical panel concluded that better integration of primary, behavioral and physical care will reduce the number of opioid prescriptions and, at the same time, improve pain symptoms.

A collaborative approach to spine care that involves a variety of non-surgical therapy options, including exercise and movement, is fast-becoming the most cost-effective option with better long-term outcomes. Here's one example of what this looks like in real life:  

One of our recent patients, Susan, had utilized the same primary care physician for twenty years to treat her chronic low back pain. After two decades of opioids and cortisone shots, Susan changed up her healthcare provider and decided to experience our integrated model of care. Rather than only receiving a prescription for pain medication, our primary care providers immediately referred Susan to our physical medicine team.

We introduced her to new treatment alternatives like physical therapy and acupuncture, which helped her to "manage pain better and stand on her feet much sooner." Integrated care models allow patients to explore a variety of options for care in a convenient and time-efficient way, ultimately arriving at the best pain management solutions faster.

Integrated care models are better able to address all the aspects of a person's pain experience and help them avoid unnecessary treatment approaches. Low back pain treatments should be informed by evidence-based practices which utilize exercise and movement approaches to healing and be centered on each patient's distinct symptoms and needs.

Such personalized and patient-centered care must include commitment and collaboration among providers who are educated in pain management. The future of workplace wellbeing will depend upon better collaboration among healthcare providers and more effective, integrated, and preventive treatments to low back pain.

About the Author

Eric Lederhaus and Rebecca Sanders Fung are physical therapists who earned doctorates in Physical Therapy and are board certified in Orthopedics. As providers at Crossover Health, Eric and Rebecca collaborate alongside primary care physicians, acupuncturists, chiropractors, behavioral health specialists, health coaches, and optometrists to provide innovative, integrated care.  

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