As self-insured employers know well, low back and neck pain are the top sources of healthcare spending in the U.S. The costs largely come from spending on treatment options like surgeries, injections, and imaging scans.
Though common, expensive treatment options actually aren’t the best way to treat most cases of musculoskeletal (MSK) pain – especially if patients are offered alternatives early on. As a physical therapist, I’ve seen the impact treatment timing can have on both costs and outcomes for people with musculoskeletal pain.
To start, exercise therapy is an effective – and affordable – first-line treatment for MSK pain. Early access and utilization of exercise therapy also lowers MSK costs by preventing disability and subsequent surgeries. Yet, few Americans participate in exercise therapy programs to reduce MSK-related pain.
Typically, people with a MSK condition will first seek care from a primary care provider. Often there is a “wait-and-see” approach to treating MSK pain that starts with a course of medications. Once the medications are no longer effective at reducing pain, some adults are referred to physical therapy for exercise therapy, but more often than not they are referred to a specialist and receive injections, advanced imaging, and surgery.
As a clinician, I saw this first-hand when I treated patients after joint replacement who never saw a physical therapist or participated in an exercise therapy program before undergoing surgery. I was shocked by how common this was in clinical practice, knowing that it goes against clinical practice guidelines and contributes to higher healthcare utilization and costs.
As a clinical researcher, I spent the next several years investigating this phenomenon and discovered that key barriers for patients participating in exercise therapy are convenience and engagement in the program.
Why digital care makes sense for musculoskeletal pain
Fortunately, digital care products and programs for musculoskeletal pain are novel solutions to fix the gap in receiving exercise therapy earlier in the course of care for MSK pain. The vast majority of MSK conditions can be addressed conventionally at home with exercise therapy and pain education. And technology can optimize patient engagement through a patient-centric user experience.
When I was deciding on the next step in my career, I was attracted to Fern by the idea that people in pain can access high-quality care as soon as they need it, and from their location of choice. And this was even before the pandemic disrupted how people access care.
Even under normal circumstances, it’s not always easy to access physical therapy, exercise therapy or pain education. Depending on their insurance and financial situation, the cost of a co-pay or out-of-pocket expense, time, and travel distances can be significant barriers.
Because the Fern Health program is delivered through your phone, there aren’t the usual barriers to entry associated with receiving exercise therapy by an in-person physical therapist. The program also integrates pain education, which not all clinicians have the opportunity to discuss with their patients at length over multiple sessions.
Like in a physical therapy appointment, the Fern program first makes sure the exercises are safe and appropriate for the individual patient.
We also ask about how members are feeling about their pain to screen for what are called “yellow flags” – thought patterns or other psychological symptoms that can get in the way of recovery. We track how our pain neuroscience brain training and lessons impact those thought patterns. Members also talk about any roadblocks or challenges with their Health Coach.
Once we determine the program is appropriate, members can get started right away with their daily dose of exercises. The exercise therapy piece of Fern uses exercises that are essential to any physical therapy program for back pain. We address range of motion, strength, flexibility, and other competencies that are key to recovery.
I talked about what happens when people in pain don’t get the right treatment at the right time. But what about when they do? People with chronic musculoskeletal pain who see a physical therapist first are 85% less likely to receive an opioid prescription. And those whose treatment program includes both exercise therapy and psychological components see a more significant and longer-lasting reduction in pain than those who try exercise therapy alone.
Whether your care options are limited because of the pandemic or more everyday barriers, it’s challenging for many people to access back pain treatment as soon as they need it. Timing counts, and I’m proud that the Fern program can meet people right away, wherever they are.
Meredith Christiansen, DPT, PhD, is a Clinical Research Scientist at Fern Health.