One of the most common and costly conditions in America, low-back pain is second only to the common cold in terms of complaints to primary care physicians. The total cost of low-back pain exceeds $100 billion per year.

While virtually everyone experiences low-back pain at some point, less than five percent of those who do account for 75 percent of the costs associated with it. In new research supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), Jeffrey N. Katz, M.D., reviewed the scientific literature concerning low-back pain and examined the costs - both direct (medications, hospitalization, outpatient visits) and indirect (lost wages, decreased productivity, care-giving expenses) - of this common problem and the role that socioeconomic factors play in it.

Following are some key findings of that research reported in the Journal of Bone and Joint Surgery:

  • Socioeconomic factors (including job dissatisfaction, physically strenuous work, psychologically stressful work, low educational attainment, and Workers' Compensation Insurance) are important risk factors for the onset of back pain and disability in general, as are smoking, obesity, older age and issues such as anxiety and depression.
  • Socioeconomic factors are not major risk factors for the development of radiographically apparent disc degeneration (that is, x-ray visible degeneration of the cartilage discs separating and cushioning the vertebrae).
  • The direct costs of low-back pain vary considerably by provider specialty, patient race and nation. For example, the use of x-rays and other tests was lower among black patients with low-back pain than among white patients; the use of surgery to treat low-back pain varied widely among developed countries, with the highest rate of such surgery in the United States.
  • Five percent of Americans miss at least one day of work annually due to low-back pain.
  • Data from many sources indicate that more than 80 percent of workers who report an episode of low-back pain return to work within one month; more than 90 percent return by three months and five percent never return. By the time a worker has been out work for six months, the likelihood of returning to work is just 50 percent; and by the time a worker has been out for year, the likelihood of ever returning to work drops to 25 percent.

"These data indicate that there is little rationale for aggressively treating injured workers in the first week or two of the episode," says Dr. Katz, who is co-director of the Brigham Spine Center at Brigham and Women's Hospital in Boston. "However, there is compelling rationale for intervening in the subacute period - between two to four weeks and six months - because of the increasing likelihood that those who remain out of work have a diminishing probability of ever returning."

While socioeconomic status is not always a precise or consistent measure - particularly in married women, students and people with disabilities whose occupations and incomes tend to be variable - it is clear that socioeconomic status is associated with important health consequences, says Dr. Katz. Conversely, health has important socioeconomic consequences.

His work reiterates the enormity of the problem of low-back pain and its toll on society, and emphasizes the critical importance of identifying strategies for preventing these disorders and their consequences.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services' National Institutes of Health, is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site at

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Katz, JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg 2006;88-A Supplement:21-24.

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