The Price of Pain

After what seemed like a minor fall, Bruce Wilson began having back pain. That was 25 years ago. Since then the former manufacturing executive, now 60, has had seven operations—at a cost to insurance companies of $278,000. Yet Wilson's back still hurts, and he spends hundreds of dollars a month on pain relievers and other medications.

Now a surgery vet, Wilson has some hard-won advice for other sufferers: "I'd tell young people with back problems that they should try the nonsurgical avenues first." When doctors recommend an operation, says the Seattle resident, "we're all too quick to agree. As a society, we all want instant gratification or instant relief."

Despite a growing array of sophisticated drugs, diagnostics, physical therapies, and surgical techniques, the millions of Americans battling back pain may not be any closer to getting that quick relief than they were 20 years ago. Several recent studies indicate that even with the latest in high-tech medical intervention, effective treatments for back problems remain elusive. And in any case, the price tag is staggering.

In 2005 Americans spent $85.9 billion looking for relief from back and neck pain through surgery, doctor's visits, X-rays, MRI scans and medications, up from $52.1 billion in 1997, according to a study in the Feb. 13 issue of the Journal of the American Medical Association (JAMA). That money hasn't helped reduce the number of sufferers; in 2005, 15 percent of U.S. adults reported back problems—up from 12 percent in 1997.

Not only are more people seeking treatment for back pain, but the price of treatment per person is also up. In the JAMA study, researchers at the University of Washington and Oregon Health & Science University compared national data from 3,179 adult patients who reported spine problems in 1997 to 3,187 who reported them in 2005—and found that inflation-adjusted annual medical costs increased from $4,695 per person to $6,096.

Spinal patient costs were also significantly higher than for nonspinal patients. "People with back problems cost 76 percent more on average than people without back problems each year," says study co-author Brook Martin, a research scientist at the University of Washington.

"We seem to be doing more and more," says Dr. Rick Deyo, co-author of the JAMA report and Kaiser Permanente professor of evidence-based family medicine at Oregon Health & Science University. "[But] there's no evidence that people are getting more pain relief." In fact, they self-reported more work limitations and poorer functioning in 2005 than in 1997, he says. "This suggests to me that we're overtreating a lot of people, and we're providing a lot of services that may not be very beneficial."