Back Pain and Presenteeism
Tue June 21st 2016
It is estimated that over half of all Americans live with chronic or recurrent pain, and the leading causes are headache, back or neck pain (The American Academy of Pain Medicine). Back pain has also been identified as the leading cause of disability in young adults in the United Kingdom leading to over 100 million days of lost work.
The annual cost of lost productivity in 2010 dollars has been estimated in the USA to be in excess of $300 billion with over three quarters of the cost being explained by health related issues causing reduced performance whilst at work rather than by actual absence from work (presenteeism).
40% of workers interviewed identified pain as interfering with their mood, sleep, activities, and their ability to work and enjoy life in general, with almost 70% reporting a disturbance in at least one of these areas.
In 2012 researchers at the Johns Hopkins University also reported that the total cost of chronic pain in the USA was a staggering $635 billion. To put that figure in context it is more than the total cost for cancer, heart disease and diabetes combined or to put another way, chronic pain cost American society more that the entire defense force budget in 2012!
So what is going on?
Back pain continues to be one of the leading causes of disability in the Western World, and one of the most expensive. The total cost is approximately 50% lost productivity and 50% in direct healthcare costs. Since the late 19th century there have been many theories as to the causes of low back pain and even more therapies aimed at 'fixing' the problem. Millions of dollars have been spent in researching low back pain, including my own research into some of the reasons why people don't recover from an episode of low back pain as we might expect. It's a complex problem with many factors combining to disable people and preventing them from being able to recover. The severity of the pain at onset and the person's reaction to it being highly predictive of recovery when combined with memory (previous experience) stress, distress, anxiety or depression.
In the late 20th century back pain had tended to become over medicalized particularly with the advent of sophisticated diagnostic imaging techniques. It was assumed that scans would take the guess work out of what was going on, and many people today still believe that a scan will provide a definitive answer to their problem. However this is not the case, 60% of people who are not experiencing any back pain at all have been shown to have a bulging inter-vertebral disk (often diagnosed as the culprit in low back pain) in their scans. It is also known that having an MRI scan increases the chances of being offered surgery for back pain as well as potentially increasing the levels of pain and disability of the individual. Thankfully diseases of the spine are rare, but whilst people continue to suffer and the costs continue to mount society's response to the problem need to shift away from the expectation of a bio-medical solution to a more biopsychosocial view. Researchers and research based organizations have recognized this for many years but the model is still both poorly understood or integrated into routine care for back problems.
This was first attempted by the production of evidence-based guidelines for the management of short-term (known as acute) low back pain around the world during the nineteen nineties. The intent was that all health care providers would then advise people according to what was then known as 'best practice 'that included keeping active and self-managing the problem with simple pain relief and anti-inflammatory medications available over the counter. However changing beliefs that had been around 100 years proved to be difficult!
In more recent times a shift has been occurring as our understanding of pain and how it is produced and experienced has changed. Education on the neurophysiology of pain can reduce its 'threat' to the individual and empower them to take control themselves. When combined with mindfulness this may be a significant step towards what Aboriginal people in Australia already appear to know! Accepting that chronic pain may be an integral part of human existence and not struggling to either find an answer for it or 'fix it' may in fact allow it to dissipate and allow us to reconnect with what brings value and meaning to our lives.
A recent editorial in The Journal of The American Medical Association commented on some high quality research published in their journal on the potential utility of mindfulness in chronic low back pain. The editors suggested that the research constituted compelling evidence for the introduction of such mind/body interventions but noted that access for Physicians to refer into such programs, or patients to locate them needs to be improved. We have been working on solution to this problem and recently released an online program of pain education combined with mindfulness training (www.drnickpenney.com).
A free webinar to launch the program is scheduled for the end of June 2016 and registrations are available through the following link. By registering for the webinar registrants will also be able to watch a replay at a later date.
For Course Information: http://dr-nicks-courses.thinkific.com/courses/chro...