Low back pain is the second most common chronic condition people see a doctor for and the fifth most common reason for hospitalization. It is the third most common reason for surgery and most the common cause of job-related disability.
In America's Bitter Pill, Steven Brill writes that the U.S. spends $85.9 billion a year on back pain, more than it spends on state, county, and city/town police forces In fact the figure is comparable to the annual revenues of a Fortune 500 company like Home Depot.
Because of low back pain's huge costs to patients and employers in lost work time, researchers try to predict and hopefully prevent it. They have found that if someone has a tendency toward depression and avoids regular activity out of fear of pain, their low back pain is likely to get worse and could even become disabling.
But the good news, however, is an estimated 90 percent of sufferers will recover from back pain in a few months with or without the wide variety of treatments currently available. One medical journal reported that 30 to 60 percent of patients recovered in one week, 60 to 90 in six weeks and 95 recover in 12 weeks.
Clearly, conservative treatment and a "wait and see" makes sense. When Denmark implemented such care which included education, conservative treatment and "watchful waiting," it cut the rate of lumbar disc surgery in half in just four years.
The fact that low back pain seldom has a single functional basis and will usually go away on its own without treatment has not stopped Pharma and surgeons from cashing in. In 2015, opioids were the most commonly prescribed drug class despite their addictive potential and only short term analgesic efficacy. And surgery? "Although disc protrusions detected on X-ray are often blamed, they rarely are responsible for the pain, and surgery is seldom successful at alleviating it," says an article in the Bulletin of the World Health Organization.
No wonder a Journal of the American Medical Association (JAMA) calls low back pain over-diagnosed and overtreated, especially due to its financial relationship to workplace injuries. "The back 'injury' construct holds that physical demands that render the pain less tolerable are the proximate cause of the back pain and hence the agent of 'injury,'" the authors write. Yet, back pain can no more be said to be "caused" by the workplace than the common cold, write Hadler et al.
Why do dangerous and ineffective treatments persist despite their lack of results? Just good marketing and medical greed. The reason is the "intense competition by pharmaceutical companies, surgical instrument makers, and device manufacturers to convince stakeholders of the beneﬁts of their products," says a 2008 article in Spine Journal. "Only rarely do such promotional materials accurately present the scientiﬁc evidence under-pinning a particular approach, and rarer still are discussions of potential harms."
Clearly the low back pain "biz" is not going away any time soon. Sadly, half of what the U.S. spends on back pain is likely wasted says Steven Brill.