How much does Back Pain cost Australia each year?
The prevalence of back pain and the associated costs are astounding. In the most recent data available from the Australian Institute of Health and Welfare (for the year of 2008-09) the economic burden of back pain in Australia was reported to be 1.2 billion dollars (560 million from admitted patient costs, 464 million for out-of-hospital costs and 153 million from prescription pharmaceuticals). (AIHW Disease Expenditure Database, 2016).
Woah, lets just let thank sink in a little… $1.2 billion with a B! Additionally, that number has probably increased in the last few years!
Imaging and Back Pain
Now-a-days Doctors and Physios (should) only refer for scans if there is a severe, progressive neurological deficit, or signs and symptoms that suggest a serious or specific underlying pathology or condition. In everyone else, the evidence tells us that routine imaging does not add any clinical benefit and can actually lead to worse outcomes for the patient (Chou et al. 2011). Not to mention the cost of getting an MRI or CT scan.
A recent systematic review (Brinjikj et al. 2015) that looked at imaging in asymptomatic (pain-free) individuals showed just how common degenerative findings were in MRIs and CT scans amongst these individuals (see below table).
What does this mean for my ‘slipped’ or ‘bulging’ disc?
Bulging discs are an extremely common finding in people who do not have pain, to the point where if you are over 40 years old and you don’t have a bulging disc, you’re actually in the minority! Additionally, its uncommon not to have ‘disc degeneration’ if you are over 30 years old. Even if you are under 30 and have ‘disc degeneration’, thats relatively common and not diagnostic of pain or function. So to simplify, the pain you feel in your back or neck, might not be coming from your ‘slipped’ or ‘bulging’ disc!
Okay, if you are still having a hard time understanding that a ‘bulging disc’ or ‘disc degeneration’ (both scary terms) are normal findings, try to think of them as grey hairs, wrinkles or balding. All painless indicators of ageing.
Don’t get me wrong, MRI and CT scans are amazing, and medical imaging and technology has come a long way to give us this unique insight into the body. But the results need to be correlated with clinical findings in each individual. We need to understand that for the back (and to a degree for other body parts), imaging rarely tells us if the individual is experiencing symptoms or pain (i.e. they are not diagnostic of function/pain).
The multi-factorial nature of pain
Pain of any nature, and in particular if its been there for a long period of time, is influenced by many things (sleep, stress, mood etc), not just the body’s structures and tissues (muscles, ligaments, discs etc). Identifying/understanding these contributing factors (which are very different amongst individuals), and addressing them is the key to restoring function and therefore relieving symptoms (this is where Physio comes in).
So instead of worrying about potential degenerative findings in your back, which results in all kinds of funky behaviours such as fear avoidance, leading to decreased physical activity and movement, see a Physio and get moving again! Questions, queries or concerns? Give us a call or enquire online!
Happy learning!
Kevin Wernli (Physiotherapist at Ferry Rd Physio on the Gold Coast, Queensland)
Persistent pain does not have to be persistent!
See below for a summary of the key information highlighted in this blog post!
References:
AIHW Disease Expenditure Database: How much is spent on back problems? http://www.aihw.gov.au/back-problems/expenditure/
Chou R, Qaseem A, Owens DK, Shekelle P, for the Clinical Guidelines Committee of the American College of Physicians. Diagnostic Imaging for Low Back Pain.: Advice for High-Value Health Care From the American College of Physicians. Ann Intern Med. 2011;154:181-189. doi:10.7326/0003-4819-154-3-201102010-00008 http://www.ncbi.nlm.nih.gov/pubmed/21282698
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR American journal of neuroradiology. 2015;36(4):811-816. doi:10.3174/ajnr.A4173. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/pdf/nihms-696022.pdf
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