The Doctor Game: Little relief and high costs for back pain

A humorous greeting card reads, "Technically I’m still young, but due to my back pain, I’m actually 90." Whatever the age, including 99, back pain can be agonizing. It's a surprisingly common problem.

A new study published by the Lancet Rheumatology Journal reports that 619 million people suffer from low back pain globally. That's nearly 10 percent of the world's population!

Why so many people? With higher numbers of people living longer, in part it's the mathematics. The older one gets, the greater the risk. By 99 years of age, the probability of living with back pain is high.

In addition to aging, what else causes the trouble? It is no surprise that researchers found obesity high on the list. Their finding that smoking is another cause of back pain is more curious. It's thought that damaged arteries in the spinal column and joints cause the pain. Smoking also contributes to osteoporosis, the bone-thinning disease that can lead to a rounded spine and back pain.

According to the study, back pain occurs more in women than men. The reasons range from the effects of pregnancy and hormone changes to higher rates of osteoporosis. By the demographic numbers, with substantially more older women than men in the world, there are more female sufferers.

What's the economic effect? Back pain among the working-age population means higher absenteeism from work, lower productivity among those at work, and early exits from employment, often with costly disability payments.

In the U.S., a 2016 study by the Institute for Health Metrics and Evaluation at the University of Washington's School of Medicine assessed the costs associated with 154 conditions. The Institute reported "low back and neck pain generated the highest expenditures at $134.5 billion. When combined with all other musculoskeletal disorders, such as joint and limb pain, osteoarthritis, and rheumatoid arthritis, the total exceeds $380 billion." Think about that.

What about the other chronic conditions that get prominent headlines? According to the study, "other health conditions with substantial spending in 2016 were diabetes ($111.2 billion), ischemic heart disease ($89.3 billion), and falls ($87.4 billion)." What's the key message? Back pain is a gargantuan financial problem for health care systems, public or private.

And watch out. With aging populations in most countries, fewer numbers of young people are being more heavily saddled to pay these costs.

It's discouraging that after so much study, there are few signs of new treatments that relieve the pain or cure the problem. The long standard prescription for acute pain is bedrest, heat treatments, and painkillers. With time, the pain goes away. But for chronic pain, it's not so easy.

X-Rays or MRI can help pinpoint the source of pain. Some people try acupuncture and get relief. Others have success with chiropractors.

Another option is a fluoroscopy procedure on the facet joints of the spine. It does not require a general anesthetic. A needle injection numbs the joint and during a 30-minute procedure a small instrument destroys targeted spinal nerves. It works for some, not for others.

When there's no help to relieve the pain, what do you do? You search for your own ways to make life more comfortable.

People who know the challenges of living with chronic back pain don't need an autopsy to find out why gravity is so brutal. What's needed is a solution to the knowledge that this pain will be with them to their dying day.

A word to the young, from Socrates, the greatest thinker of ancient Greece, who said, "If you would seek health, look first to the spine."

Dr. W. Gifford-Jones, aka Ken Walker, is a graduate of the University of Toronto and Harvard Medical School. You can reach him online at his website, docgiff.com, or via email at contact-us@ docgiff.com. Follow him and his daughter on Instagram @docgiff and @diana_gifford_jones.

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