How Back Pain Impacts the Bottom Line of American Business


If you are one of the more than 30% of Americans who will suffer a low back pain episode this year, you are all too aware of the impact on your quality of life and pocketbook.

What you may not be aware of is the impact on your employer.

According to the World Health Organization (WHO), low back pain is a leading health-related economic drain, with annual U.S. costs exceeding $100 billion (yes, billion).  Low back pain is a fixture on the WHO’s top twelve priority disease list not only because of its prevalence and impact on well-being, but also because of its impact on disability and work performance.

Low back pain disproportionately affects workers.  According to the United States Bone and Joint Initiative, 72% of adult low back pain healthcare visits are attributable to those under age 64, with prevalence peaking between the ages of 35 and 55 (WHO).  While certain industries are associated with higher than average back pain, desk workers are not immune.  In fact, 54% of those experiencing low back pain spend the majority of their workday sitting.  Furthermore, back pain is rising in younger workers, who spend an increasing number of hours hunched over tablets and smartphones.

So how does this impact the bottom line of American business?

Medical costs

Medical costs are borne by employers either directly, for those 63% of employers who are fully or partially self-funded, or indirectly, in the form of health insurance premiums.

Low back pain falls in the top three medical cost drivers for most healthcare payers.  Why so high?  It’s the second leading reason for primary care visits, and a significant percentage of patients are prescribed additional diagnostics and services.

What do we get for those dollars?  Unfortunately, not as much as we should expect.

Spending more and achieving less

Prescription rates for opioids, MRI imaging, epidural steroid injections, and spine surgery have climbed significantly over the past twenty years, with a corresponding rise in costs for those services.  But rather than declining in response to increased treatment, functional limitations and disability rates have risen during this same period.  It is only the relative intransparency of healthcare cost-to-benefit ratios that prevents this discordance from receiving the attention it deserves from corporate CFOs, benefits and wellness directors, and small business owners.

In addition to costs directly related to low back pain, sufferers are at increased risk for concurrent health issues, including depression, chronic fatigue, and obesity.  This not only complicates recovery, but also increases costs.  According to researchers at the University of Washington, Oregon Health & Science University, and Dartmouth Medical School, medical costs for individuals with low back pain are about 75% higher than costs for those without back pain.

Impact on worker’s compensation & disability costs

For low back pain, worker’s comp injuries are usually related to ergonomics and over-exertion.  A typical claim for a back injury runs $40,000 to $80,000, according to Ohio State University’s Spine Research Institute.

Low back pain is the leading cause of work-related disability in the U.S. (National Institutes for Health).  A 2013 survey found that 30% of chronic back pain sufferers reported filing for disability.  The Integrated Benefits Institute (IBI), a nonprofit workforce health and productivity research and analysis organization, calculates the cost per 100 workers of low back pain-related long- and short-term disability at $11,300 per year.

Hidden employment costs of back pain

Indirect costs include both absenteeism (missed work days) and presenteeism (reduced productivity while at work).  The costs to a business include lost production, idle assets, and benefit and payroll costs.  Absenteeism and presenteeism make up more than two-thirds of the total cost of low back pain to employers, according to IBI.

Low back pain is the leading cause of lost work days and activity limitation (WHO), and is responsible for about 40% of missed work days.  The American Academy of Orthopaedic Surgeons found that in 2004, 25.9 million persons lost an average of 7.2 days of work due to back pain.  Primary care studies in chronic low back pain patients have found that average loss to be as high as 12 missed work days.

Additional indirect costs to employers include the cost of hiring and training new workers to replace workers temporarily or permanently unable to perform their job functions.  One in five workers are unable to return to work within a month of an episode; one in ten are unable to return within three months, and one in twenty are permanently disabled.  The median cost of replacing a worker?  About 21% of annual salary, according to the American Center for Progress, with costs significantly higher for those making over $75,000 per year and those with specialized education.

What works to reduce corporate costs of employee back pain

In part two of this series, we will look at ways employers can reduce the burden of low back pain on their employees and on their bottom line.

Lydia Zeller is Kiio’s Director of Engagement Solutions. She can be reached at lzeller@kiio.com.

Opioids and Low Back Pain – Changing the Paradigm


A Rising Epidemic

With more than 30 percent of Americans experiencing an episode every year, it’s no surprise that low back pain is a leading reason for physician visits.

Too often, that visit results in an opioid prescription, leading to low back pain sufferers making up more than half of regular prescription opioid users. According to National Medical Expenditure Panel Survey (MEPS), opioid prescriptions for back pain have increased dramatically over the last 20 years, without a correlated decrease in the amount of pain reported.

This is problematic for two reasons.

The American Society of Addiction Medicine lists drug overdose as the leading cause of accidental death in 2015 and the Centers for Disease Prevention and Control (CDC) reports that opioid prescriptions are a driving factor in the 15-year increase in opioid overdose deaths, with deaths attributed to prescription opioids quadrupling since 1999. The link to heroin and other opioid abuse is also well documented, with over three quarters of abusers reporting their first opioid was prescribed. Even for adherent users, common opioid side effects can be unconducive to good quality of life.

Second, opioids have been clinically proven to be inefficacious for treatment of low back pain. They may temporarily mask pain but they do not expedite return to work or improve functional outcomes in acute low back pain, nor have they been shown effective in long-term management of chronic low back pain.

Evidence-Based Treatment of Low Back Pain

Last month, the American College of Physicians (ACP) issued a clinical practice guideline recommending doctors avoid opioids in the treatment of nonradicular low back pain and instead prescribe exercise, rehabilitation or alternative therapies. This guideline was issued based on an extensive review of peer-reviewed research, including randomized control trials and data from observational studies.

All stakeholders, including providers, healthcare payers and patients, benefit from care that follows treatment pathways grounded in evidence-based best practice. Unfortunately, current treatment practices for low back pain vary widely, often resulting in increased costs and failure to meet outcome goals.

In addition to the ACP recommendations, a body of clinical research exists to provide guidance in the development of evidence-based care pathways. Innovations in care delivery models and technology play an important role as they facilitate practical implementation of evidence-based care and connect stakeholders. We will be talking more about specific research and care delivery innovations in upcoming posts.

A Team Approach

We all have a stake in designing and demanding care that leverages the best that both science and technology offer in delivering value. The shift to a team-based approach has begun, with more patients demanding tools that facilitate active participation in their healthcare as well as insurers and employers increasingly embracing a leadership role as collaborative partners in the wellness of their members and employees.

Using evidence-based care to improve low back pain will result in significantly reduced opioid prescription, reductions in other ineffectual and costly treatment and, most importantly, better results.

Lydia Zeller is Kiio’s Director of Patient Engagement. She can be reached at lzeller@kiio.com.