For 85% of employers, musculoskeletal conditions like low back pain are one of the top three drivers of healthcare costs. Those high numbers are driven by two key factors: Back pain is extremely common – 80% of people experience low back pain at some point in their lives. And it’s also one of the most challenging conditions to treat.
People with back pain make 52 million health care visits a year. Common back pain solutions, particularly surgery, don’t necessarily bring relief. Studies show that up to 87% of those who receive spinal surgery are still in pain two years later.
This doesn’t mean that surgery is never the right option for patients. Back pain treatment just isn’t one-size-fits-all. Some solutions aren’t specific enough to help individual cases of back pain. Others don’t address all of the challenges associated with back pain.
As employers look for solutions for back pain in the workplace, it’s smart to consider why common back pain solutions don’t always work – and what helps them work better.
Problem 1: Patients aren’t always directed to the right solutions.
When a patient first visits the doctor for back pain, doctors check for red flags to make sure patients aren’t suffering from an infection, fracture, or another serious problem.
Once that’s out of the way, the first line of treatment for most lower back pain might be a surprise: Keep moving. Bed rest is actually one the worst ways to treat most cases of back pain, despite popular opinion.
Why? Sedentary lifestyles are already partly to blame for many back pain cases in the first place. The spine needs support from our back and abdominal muscles. Studies show that even gentle exercise like walking helps strengthen muscles and improve blood flow. Staying home in bed also reduces social interactions, which can contribute to depression – another factor that makes pain worse.
Imaging scans are not part of the first line of treatment, unless there is a real need to rule out specific cause of pain. In practice, however, 54% of people with back pain receive an imaging scan, such as an MRI.
Results from MRI scans can be misleading. Most people will show some abnormalities in an MRI scan, whether or not they’re experiencing pain. For example, among people over 60 without any back pain symptoms, over 90% had a degenerated or bulging disc.
These misleading results can send patients on a path towards inappropriate treatments, such as steroid injections or even surgery – all before even trying exercise therapy. Unnecessary imaging also adds on significant costs. A single MRI scan runs $2,600 on average in the U.S.
Problem 2: Back pain solutions aren’t personalized enough.
Even if patients receive the correct recommendation based on general guidelines, they may not get the results they’re looking for because of a lack of personalization.
A study in the UK set out to better understand why 80% of people still reported back pain or disability a year after consulting their general practitioner. The study grouped participants into low, medium, or high-risk of persistent pain and disability. They then matched patients to a recommended treatment option based on their risk group.
The study resulted in a 20% reduction in opioid prescriptions and reduced x-ray orders, too. Those in the study were also more likely to be referred to physical therapy if they were at risk of poor outcomes.
Simply directing patients to physical therapy isn’t always enough, however. Around half of physical therapists don’t follow evidence-based guidelines when treating musculoskeletal (MSK) conditions, like back pain. That means even those who receive physical therapy may not be getting care that’s designed to treat their specific pain.
Problem 3: Most back pain solutions don’t include a psychological element.
Back pain isn’t just physical – there’s a significant mental component, too.
Depression can make pain feel worse. Chronic pain can cause isolation and frustration that contributes to depression. And this cycle is common: Sixty-five percent of people with depression also report chronic pain. People with chronic back pain are three times more likely to experience depression.
Even for those who haven’t been diagnosed with depression or an anxiety disorder, beliefs about pain can also get in the way of a quick recovery.
If you’re afraid that movement will make your pain worse, you’ll stay sedentary. Lack of movement can make pain worse, which can lead to depressed and hopeless feelings and start the cycle back again.
Taking the mental side of pain into account is important, but rarely happens. Clinical guidelines recommend cognitive behavioral therapy (CBT) for back pain treatment, but only 8% of low back pain patients receive it.
Even if patients are directed toward therapy for help with pain management, it can be difficult to access. Sixty percent of counties in the U.S. don’t have a single psychiatrist.
People in pain who are able to access both appropriate physical therapy and mental health care then have to balance scheduling multiple appointments. Multiple providers are also unlikely to communicate with each other.
Finding a holistic back pain solution
Back pain requires a multi-pronged approach, but it can be difficult to access patient-specific care that addresses both the physical and psychological sides of pain.
Digitally-delivered programs solve for access, and can also be more specific and include more personalization than in-person physical therapy.
We developed the Fern program in collaboration with top patient-focused health organizations specifically for lower back pain. The program is also personalized – it adapts as members use it and get stronger. Fern also incorporates pain neuroscience education throughout to address beliefs about pain and build management skills.
The wrong back pain treatment can send patients down a frustrating path away from the right treatments and towards expensive, ineffective care. With a digital solution, employers can reach people in pain where they are and provide them with the specific care they need to start feeling better.