Consumer spending for spinal treatments rose 65% from 1997 to 2005, faster than overall health spending, with patients spending $86 billion to treat back and neck problems. These treatments included drugs, outpatient procedures, ER visits and surgery. However, back pain during the same period appears to have gotten more debilitating. In both 1997 and 2005, 14% of about 23,000 respondents to a national survey reported back pain. Of those patients, 25% reported spinal problems that limited function in 2005, up from 21% in 1997. "You'd think if you're putting a lot of money into a problem, you'd see some improvements in health status," said Brook I. Martin, the study's lead author, as quoted by the New York Times.
Much of the increased expenditure was attributed to drugs. Between 1997 and 2005, use of drug treatments rose 171% to $20 billion, with a particular spike (400%) in the use of narcotic painkillers. Additionally, outpatient treatment rose to $31 billion, a 74% increase, and spending related to emergency room visits rose to $2.6 billion, a 46% increase.
Spending on surgeries and other inpatient procedures increased 25% to $24 billion between 1997 and 2005, despite a lack of consensus on the effectiveness of surgical treatment. The SPORT study has leant credit to fusion, with patients who underwent a surgical intervention experiencing better outcomes than those who did not, but spine surgery remains a field where there is little rigorous data. The lack of strong evidence and the associated lack of a standard of care emerges in a comment from Dr. Richard Deyo, a coauthor on the report, who told the Times, "All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we've begun using those tests or treatments more widely than science would really support."
There is no obvious cause for the apparent worsening of back pain; the study's authors suggested obesity could be a factor. The data was controlled for age, reducing the impact of an aging population. Also a possibility is that a general awareness of spinal problems evolved between 1997 and 2005, affecting diagnoses as well as how patients perceive their condition (all data was self-reported.) It is also impossible to know what combinations of treatments respondents used or the effectiveness of any individual treatment. What the data does reveal is that people are in pain and increasingly inclined to seek treatment, an opportunity for the spine industry that should be met with innovation and strong data.
