Back Pain: Massive Problem, Badly Treated

The burden of back pain

Why are better approaches to helping sufferers so slow to spread?

Jan 18th 2020

Pete Moore was 43 when he woke up one autumn morning with back pain so excruciating that he struggled to dress himself.

His doctor in Romford, an English town, referred him to hospital for an mri scan; this showed that some of the spongelike discs that separate the spine’s vertebrae were bulging out of the slots into which they customarily fit.

Such “slipped” discs can be caused by an injury; but they are also the sort of thing which can just happen with increasing age.

Mr Moore received a prescription for opioids to help him cope with the pain; but the pain persisted, and he found himself becoming loopy.

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Unable to work or do much else, Mr Moore, who had been a painter, sank into depression. Three years into his ordeal, he says, he was “thinking of ending it all”.

Back pain does not, in and of itself, kill people. But it makes a huge number of lives a misery.

In most countries for which there are reliable figures, whether rich or poor, back pain is the top cause of disability, measured by the aggregate number of years lived in poor health. That burden is decreasing (see chart) but only very slowly.

The costs, however, have been rising quite quickly—and are enormous. In 2013, according to one study, $88bn was spent on medical treatments for back and neck pain in America, not far short of the $115bn spent on cancer (more recent figures have not been analysed in a comparable way). A great deal of this money seems, sadly, to do little good.

Doctors used to think that back pain was almost entirely the result of mechanical damage to tissue beyond the capacity of x-rays to detect. Read more. 

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