Health Care Costs and Opioid Use Associated With High-impact Chronic Spinal Pain in the United States

Abstract

Study Design. A descriptive analysis of secondary data. Objective. The aim of this study was to estimate health care costs and opioid use for those with high-impact chronic spinal (back and neck) pain. Summary of Background Data. The US National Pain Strategy introduced a focus on high-impact chronic pain—that is, chronic pain associated with work, social, and self-care restrictions. Chronic neck and low-back pain are common, costly, and associated with long-term opioid use. Although chronic pain is not homogenous, most estimates of its costs are averages that ignore severity (impact). Methods. We used 2003 to 2015 Medical Expenditures Panel Survey (MEPS) data to identify individuals with chronic spinal pain, their health care expenditures, and use of opioids. We developed prediction models to identify those with high- versus moderate- and low-impact chronic spinal pain based on the variables available in MEPS. Results. We found that overall and spine-related health care costs, and the use and dosage of opioids increased significantly with chronic pain impact levels. Overall and spine-related annual per person health care costs for those with high-impact chronic pain ($14,661 SE: $814; and $5979 SE: $471, respectively) were more than double that of those with low-impact, but still clinically significant, chronic pain ($6371 SE: $557; and $2300 SE: $328). Those with high-impact chronic spinal pain also use spine-related opioids at a rate almost four times that of those with low-impact pain (48.4% vs. 12.4%), and on average use over five times the morphine equivalent daily dose (MEDD) in mg (15.3 SE: 1.4 vs. 2.7 SE: 0.6). Opioid use and dosing increased significantly across years, but the increase in inflation-adjusted health care costs was not statistically significant. Conclusion. Although most studies of chronic spinal pain do not differentiate participants by the impact of their chronic pain, these estimates highlight the importance of identifying chronic pain levels and focusing on those with high-impact chronic pain. Level of Evidence: 3

Exploring supervised machine learning approaches to predicting Veterans Health Administration chiropractic service utilization

“…Spinal pain conditions, including low back pain and neck pain, are among the most common musculoskeletal pain conditions and contribute greatly to the high prevalence of chronic pain, with 6.0% of U.S. adults experiencing chronic spinal pain and 2.2% experiencing high-impact chronic spinal pain [3]. Spinal pain conditions carry high spine-related and overall healthcare costs, with an average of $3915 spent on spine-related healthcare and $9781 on overall healthcare costs per chronic spinal pain patient per year [3]. High-impact chronic spinal pain carries even greater direct costs ($5979 for spine-related healthcare and $14,661 for overall healthcare).…”

Association between objectively measured physical behaviour and neck‐ and/or low back pain: A systematic review

“…Neck pain (NP) and low back pain (LBP) are leading causes of disability and their burden is expected to increase due to the ageing population (James et al, 2018). Both NP and LBP have high direct and indirect social and economic costs (Herman, Broten, Lavelle, Sorbero, & Coulter, 2019; Vlaeyen et al, 2018) and are common causes of work absence, reduced work productivity and early disability pension (Hartvigsen et al, 2018; Hoy et al, 2014). The severe negative consequences, both for the society and affected individuals, underscore the importance of identifying modifiable factors that can be targeted to reduce the risk and improve prognosis of NP and LBP.…”

Real-World Evidence in Prescription Medication Use Among U.S. Adults with Neck Pain

“…Opioid use and the use of other analgesics in combination with opioids increase with pain impact levels [9,43,44]. One study showed that early physical therapy for neck pain may decrease total treatment costs and the use of prescription medicines, including opioids [45].…”

“…Opioids only should be used after careful consideration and only for short-to medium-term treatment [8]. Previous studies have shown that excessive opioid use for neck pain is very common in the USA [9][10][11][12].…”