An estimated 126.6 million Americans (one in two adults) are affected by a musculoskeletal condition–comparable to the total percentage of Americans living with a chronic lung or heart condition–costing an estimated $213 billion in annual treatment, care and lost wages, according to a new report issued today by the United States Bone and Joint Initiative (USBJI).
Musculoskeletal disorders–conditions and injuries affecting the bones, joints and muscles–can be painful and debilitating, affecting daily quality of life, activity and productivity. “The Impact of Musculoskeletal Disorders on Americans: Opportunities for Action” outlines the prevalence and projected growth of musculoskeletal disorders in the U.S., and recommends strategies for improving patient outcomes while decreasing rising health and societal costs.
“This report provides the critical data needed to understand the magnitude of the problem, and the burden, of musculoskeletal disease in our country,” said David Pisetsky, MD, USBJI president, and professor of medicine and immunology at Duke University Medical School. “The number of visits to physicians for these disorders, the cost of treating them, and the indirect costs associated with pain and loss of mobility, are proportionately much higher than the resources currently being allocated to combat these conditions and injuries.”
“As a nation, we need to establish greater funding for musculoskeletal research, improve our understanding and strategies for prevention and treatment of these injuries and conditions, and ensure that more adults and children receive appropriate treatment sooner, and on an ongoing basis, to ensure quality of life and productivity,” said Stuart L. Weinstein, MD, co-chair of the report’s Steering Committee and a professor of orthopaedics and rehabilitation at the University of Iowa Hospitals and Clinics.
Prevalence and predictions
According to the report, the most prevalent musculoskeletal disorders are arthritis and related conditions; back and neck pain; injuries from falls, work, military service and sports; and osteoporosis, a loss of bone density increasing fracture risk, primarily in older women. An estimated 126.6 million Americans were living with a musculoskeletal disorder in 2012. More specifically:
•Arthritis is the most common cause of disability, with 51.8 million–half of U.S. adults age 65 and older–suffering from the disease.
•With the aging of the American population, the report projects arthritis prevalence to increase to 67 million people, or 25 percent of the adult population, by 2030.
•Arthritis is not just a disease for older Americans, with two-thirds of arthritis sufferers under age 65.
•Back and neck pain affects nearly one in three, or 75.7 million adults.
•Osteoporosis affects 10 million Americans, with 19 million more (mostly women) at risk for the disease.
•One in two women and one in four men over the age of 50 will have an osteoporosis-related fracture, and 20 percent of hip fracture patients over age 50 will die within one year of their injury.
Cost and health care impact
The burden of musculoskeletal conditions is significant in terms of treatment and care, as well as the impact upon of quality of life, mobility, and productivity, and resulting in fewer days at work and in school. In 2011, the annual U.S. cost for treatment and lost wages related to musculoskeletal disorders was $213 billion, or 1.4 percent of the country’s gross domestic product (GDP). When adding the burden of other conditions affecting persons with musculoskeletal conditions such as diabetes, heart disease and obesity, the total indirect and direct costs rose to $874 billion, or 5.7 percent of the GDP in 2015.
Other data on the costs of musculoskeletal diseases and injuries include:
•Eighteen percent of all health care visits in 2010 were related to musculoskeletal conditions, including 52 million visits for low back pain, and 66 million for bone and joint injuries, including 14 million visits for childhood injuries.
•Arthritis and rheumatoid conditions resulted in an estimated 6.7 million annual hospitalizations.
•The average annual cost per person for treatment of a musculoskeletal condition is $7,800.
•The estimated annual cost for medical care to treat all forms of arthritis and joint pain was $580.9 billion, which represented a 131 percent increase (in 2011 dollars) over 2000.
•In 2012, 25.5 million people lost an average of 11.4 days of work due to back or neck pain, for a total of 290.8 million lost workdays in 2012 alone.
•Among children and adolescents, musculoskeletal conditions are surpassed only by respiratory infections as a cause of missed school days.
Opportunities for action
The report provides recommendations to curb the tremendous economic and societal costs of musculoskeletal disorders, including:
•Accelerating research that compares treatment alternatives, develops new treatments and evaluates possible preventative approaches.
•Improving understanding of the role of behavior change in prevention and treatment, including weight loss and self-management of conditions once they arise.
•Ensuring that a higher percentage of the affected population receives access to evidence-based treatments.
•Implementing proven prevention strategies for sports injuries, workplace injuries, and injuries in the military.
•Ensuring that all children with chronic medical and musculoskeletal problems have access to care.
•Promoting better coordination between physicians and other health care providers treating musculoskeletal disorders: primary care physicians, specialists, physical therapists, etc.
•Ensuring that health care providers, especially primary care physicians, have the appropriate training to diagnose, and if necessary, refer patients for appropriate treatment.
•Addressing data limitations, and improve systems, to improve our understanding of these conditions and how best to screen, diagnose and treat them. This includes the impact of sex and gender on musculoskeletal disorders and responses to treatment, and tracking pediatric patients through adulthood to determine the lifelong burden of musculoskeletal disease.
“If we continue on our current trajectory, we are choosing to accept more prevalence and incidence of these disorders, spiraling costs, restricted access to needed services, and less success in alleviating pain and suffering — a high cost,” said Edward H. Yelin, PhD, co-chair of the report’s steering committee, and professor of medicine and health policy at the University of California, San Francisco. “The time to act to change this scenario to one with more evidence-based interventions and effective treatments, while simultaneously focusing on prevention, doing better by our society and economy, is now.”
American Academy of Orthopaedic Surgeons. “One in two Americans have a musculoskeletal condition: New report outlines the prevalence, scope, cost and projected growth of musculoskeletal disorders in the U.S..”
Golfers with low-back pain may be helped by a University of Pittsburgh research study, the findings of which may assist clinicians in designing appropriate back-specific exercise programs for golfers to prevent or rehabilitate low-back injury.
The findings are being shown today with a poster presentation at the annual meeting of the American Orthopaedic Society for Sports Medicine,July 14-17, at the Keystone Resort in Keystone, Colo.
“More than 30 percent of golfers have experienced issues related to low-back pain or injury that have affected their ability to continue enjoying the game of golf,” said principal investigator Yung-Shen Tsai, Ph.D., P.T., of the University of Pittsburgh Neuromuscular Research Laboratory (NMRL), where the study was conducted.
“Modified swing patterns and general exercises have been suggested for golfers with back problems. However, it is difficult to design an appropriate back-specific swing or exercise program for low-back injury prevention and rehabilitation without knowing the differences in the kinematics and spinal loads of the golf swing and the physical characteristics of golfers with low-back pain,” Dr. Tsai explained.
So, Dr. Tsai’s team set out to examine the kinematics of the trunk and spinal loads in golfers with and without low-back pain (LBP)and their trunk and hip physical characteristics. Sixteen male golfers with a history of LBP were matched by age and handicap to 16 male golfers with no history of LBP. All study participants underwent a biomechanical swing analysis and physical characteristics assessment.The researchers used a 3D motion analysis system and two force plates to assess kinematics and spinal loads of the trunk. They used a bottom-up inverse dynamics procedure to calculate spinal loads of the lower back. In addition, they measured trunk and hip strength and flexibility, back proprioception and postural stability.
“We found deficits in physical characteristics in the golfers with a history of LBP compared to the non-LBP group,” reported Dr.Tsai. “These differences may hinder dissipation of the tremendous spinal forces and movements generated by the golf swing over time and limit trunk rotation during the backswing. These conditions may lead to lower back muscle strain, ligament sprain or disc degeneration.
“Although differences found in this study cannot be determined as causes or results of low-back injuries in golfers, clinicians may be able to use our data to design appropriate back-specific exercise programs for golfers to prevent or rehabilitate low-back injury,” said Dr. Tsai.
Specifically, the LBP golfers in Dr. Tsai’s study demonstrated less trunk and hip strength and less hamstring and right torso rotation flexibility. The LBP group also demonstrated back proprioception deficits significantly in trunk flexion. No significant differences were found for postural stability. The LBP group showed less maximum angular displacement between shoulders and hips during the backswing.No significant differences were found in other trunk kinematics and spinal loads during the golf swing.
Other investigators for this study were: Timothy Sell, Ph.D.,P.T.; James Smoliga, D.V.M; Joseph Myers, Ph.D., A.T.C.; Jean McCrory,Ph.D.; Richard Erhard, D.C., P.T.; and Scott Lephart, Ph.D., A.T.C.
University of Pittsburgh Medical Center. “Golfers With Low-back Pain May Be Helped By University Of Pittsburgh Research.” ScienceDaily. ScienceDaily, 18 August 2005. <www.sciencedaily.com/releases/2005/08/050814174459.htm
Health economists from Johns Hopkins University writing in The Journal of Pain reported the annual cost of chronic pain is as high as $635 billion a year, which is more than the yearly costs for cancer, heart disease and diabetes.
Previous studies have not shown a comprehensive analysis of the impact on health care and labor markets associated with people with chronic pain. The Johns Hopkins researchers estimated the annual economic costs of chronic pain in the U.S. by assessing incremental costs of health care due to pain and the indirect costs of pain from lower productivity. They compared the costs of health care for persons with chronic pain with those who do not report chronic pain.
Data from the 2008 Medical Expenditure Panel Survey was used to gauge the economic burden of pain in the United States. The sample included 20,214 individuals 18 and older to represent 210.7 million U.S. adults.
The authors defined persons with pain as those who have pain that limits their ability to work, are diagnosed with joint pain or arthritis, or have a disability that limits capacity for work. To measure indirect costs, they used a model to predict health care costs if someone has any type of pain and subtracted predicted health care costs of persons who do not have pain. The impact of incremental costs of selected pain conditions were calculated for various payers of health care services.
Results showed that mean health care expenditures for adults were $4,475. Prevalence estimates for pain conditions were 10 percent for moderate pain, 11 percent for severe pain, 33 percent for joint pain, 25 percent for arthritis, and 12 percent for functional disability. Persons with moderate pain had health care expenditures $4,516 higher than someone with no pain, and individuals with severe pain had costs $3,210 higher than those with moderate pain. Similar differences were found for other pain conditions: $4,048 higher for joint pain, $5,838 for arthritis, and $9,680 for functional disabilities.
Also, adults with pain reported missing more days from work than people without pain. Pain negatively impacted three components of productivity: work days missed, number of annual hours worked and hourly wages.
Based on their analysis of the data, the authors determined that that the total cost for pain in the United States ranged from $560 to $635 billion. Total incremental costs of health care due to pain ranged from $261 to $300 billion, and the value of lost productivity ranged from $299 to $334 billion. Compared with other major disease conditions, the per-person cost of pain is lower but the total cost is higher.
The authors noted their conclusions are conservative because the analysis did not consider the costs of pain for institutionalized and non-civilian populations, for persons under 18 and for caregivers.
The Journal of Pain is published by the American Pain Society.
Darrell J. Gaskin, Patrick Richard. The Economic Costs of Pain in the United States. The Journal of Pain, 2012; 13 (8): 715 DOI: 10.1016/j.jpain.2012.03.009
A new study published in The Journal of Pain reports that 39 million people in the United States or 19 percent have persistent pain, and the incidence varies according to age and gender. The Journal of Pain is the peer-reviewed publication of the American Pain Society, www.americanpainsociety.org.
Researchers at the Washington State University College of Nursing conducted the study. They defined persistent pain as frequent or constant pain lasting longer than three months. The intent of their research was:
• Identify groups at higher risk for persistent pain
• Identify body sites, chronic conditions and disabilities associated with persistent pain
• Assess the relationship between persistent pain and anxiety, depression and fatigue
• Describe the individual experience of persistent pain.
The study was performed using data from the 2010 Quality of Life Supplement of the National Heath Interview Survey (NHIS) to calculate the prevalence of persistent pain. Results of the analysis showed that approximately 19 percent of U.S. adults reported persistent pain in 2010, and older adults were more likely to experience persistent pain than younger adults. Women also had slightly higher risk than men.
The authors noted that persistent pain correlated with other indices of health-related quality of life, such as anxiety, depression and fatigue. Individuals with those conditions were far more likely to report persistent pain.
In 2011, the Institute of Medicine reported that 100 million Americans have chronic pain. The authors explained that the disparity between the estimated pain incidence in their study and what the IOM reported is attributable almost entirely to differences in operational definitions of persistent pain.
In the 2010 NHIS, an estimated 60 percent of adults reported lower back pain in the past three months, and all of them would have been described in the IOM report as having chronic pain. However, only 42 percent of the NHIS study respondents with back pain described their pain as frequent or daily and lasting more than three months.
From a public health perspective the difference is significant. Those with persistent pain have high rates of work disability, fatigue, anxiety and depression. They also are at higher risk for long-term exposure to and dependency on pain medications.
The authors concluded that measuring pain persistence has policy implications because persistent pain is an indicator of an unmet medical need for pain management in the general population, as well as a risk factor for anxiety and depression.
Jae Kennedy, John M. Roll, Taylor Schraudner, Sean Murphy, Sterling McPherson. Prevalence of Persistent Pain in the U.S. Adult Population: New Data From the 2010 National Health Interview Survey. The Journal of Pain, 2014; 15 (10): 979 DOI: 10.1016/j.jpain.2014.05.009