The burden of back pain
The following statistics highlight the importance of capturing Waddell’s ‘golden window of opportunity’, and if missed, may not only lead to a life of suffering for the individual and his or her family but have a substantial impact on health, social care and employment.
- The percentage of people who return to see their GP with back pain within 3 months is more than 29% (Croft et al 1998).
- The adult population prevalence of pain is thought to be 46.5% (Elliott et al 1999, Smith et al 2001)
- Adult population prevalence of severe chronic pain 5.6% - this is pain that is severe and which causes severe disability and distress (Elliott et al 1999, Smith et al 2001)
- Chronic non malignant pain (CNMP) has a similar prevalence to heart disease and diabetes
- People with CNMP have a higher all cause mortality (Torrence et al, 2010) –
- 1.38 times with CNMP, twice as likely with severe CNMP
- 2.11 times more likely to die of heart disease
- 2.45 times more likely to die of respiratory disease
- In 2002, CNMP accounted for 4.6 million GP appointments per year = 793 whole time GPs and at a cost of £69 million
- 15-22% of all GP consultations
- 10% of all prescribed medications are for chronic pain
- 1% are seen in chronic pain clinics, the rest are managed in primary care (Belsey et al 2002)
- If an individual has been off sick with back pain for 1 month, there is a 20% chance of them still being off work one year later and after 6 months off work, there is a 50% chance of them being off work one year later however this situation may be modified (Waddell 2004).
- Low back pain is estimated to affect at least 60% to 80% of the population at some time in their lives and most of these patients will have resolution of their back pain with simple measures including simple analgesia, manipulation and exercise advice (Macfarlane et al 1999).
- However, the major part of the cost of back pain, estimated to be £500 million annually to the National Health Service in the UK is from the small proportion of persons with low back pain whose symptoms become chronic (Macfarlane et al 1999).
- In the UK, 2.5 million people have back pain every day of the year and results in a total cost of £12.3 billion (22% of UK healthcare expenditure) (BackCare 2001).
- In the UK, back problems are the leading cause of disability with nearly 119 million days a year lost: one in eight unemployed people give back pain as the reason they are not working (BackCare 2001).
The estimated cost of back pain to the NHS is £481 million a year (min-max range £356 - 649 million), with non NHS costs (such as private consultations and prescriptions) being an additional £197 million (Moffett et al 1995).
This word cloud illustrates Sprangers et al (2000) data and shows the impact a number of chronic conditions have on quality of life with musculoskeletal conditions having the greatest. The larger the word, the greater the impact.
- BackCare. Back Pain Survey; 2001
- Belsey J. Primary care workload in the management of chronic pain. A retrospective cohort study using a GP database to identify resource implications for UK primary care. Journal of Medical Economics. 2002;5:39-50.
- Croft PR, MacFarlane GJ, Papageorgiou AC, Thomas E, Silman AJ. Outcome of low back pain in general practice: a prospective study. BMJ 1998; 316(7141): 1356-59.
- Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The epidemiology of chronic pain in the community. Lancet 1999;354:1248-52.
- Macfarlane GJ, Thomas E, Croft PR, Papageorgiou AC, Jayson MI, Silman AJ. Predictors of early improvement in low back pain amongst consulters to general practice: the influence of pre-morbid and episode-related factors. Pain. 1999;80:113-9.
- Moffett JK, Richardson G, Sheldon TA, et al. Back pain. Its management and cost to society. NHS centre for reviews and dissemination. Discussion paper 129. York: Centre for Health Economics, 1995.
Smith BH, Elliott AM, Chambers WA, Smith WC, Hannaford PC, Penny K. The impact of chronic pain in the community. Fam Pract 2001;18:292–9.
- Sprangers MA, et al. Which chronic conditions are associated with a better or poorer quality of life? Journal of Clinical Epidemiology. 2000;53:895-907.
- Torrance N, Elliott AM, Lee AJ, Smith BH. Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study. European Journal of Pain. 2010:14:380–386.
- Waddell G. The Back Pain Revolution. 2nd ed. Edinburgh: Churchill Livingstone; 2004.