Commentary: Battling chronic pain

1 week ago 64

Employers spend more than $800 billion annually on health benefits for their workers.

And surprisingly, the largest single driver of that spending isn’t cancer or heart disease — it’s back pain and other musculoskeletal disorders (MSK). Treating MSK costs employers $52 per month per enrollee, on average, according to an analysis from United Healthcare, the nation’s largest private insurer. Cancer, moles and other tumorous growths collectively account for $43 per enrollee per month, and chronic circulatory conditions also cost $43 per enrollee per month.

Fortunately, employers can dramatically reduce this spending while improving both the quality of care and relief from pain their employees receive.

I’m chief of physiatry at the Hospital for Special Surgery, which cares for more patients with orthopedic injuries and conditions than any facility in the country. My specialty focuses on the evaluation and treatment of patients with spine and sports-related problems. And having worked with countless patients who were sick of trying ineffective treatments, I’ve seen firsthand how raising nationwide care to the best standards of care could save billions of dollars and improve Americans’ quality of life. MSK conditions affect one in two American adults. Chronic back pain, arthritis and other MSK disorders don’t just impact our work — they affect every aspect of life, from picking up our children to enjoying our favorite hobbies.

So, how can we address this hidden driver of healthcare costs and human suffering? First, when someone experiences orthopedic pain, it’s crucial to get them on the path to recovery quickly. Currently, America does a lousy job — studies show that fewer than 10% of patients with lower back pain are referred for care within 90 days of diagnosis, despite evidence that early therapy can improve outcomes and reduce costs. We must prioritize early intervention programs for patients with conditions that aren’t improving quickly, whether they’re experiencing those issues at work, at home, or anywhere else. Second, it’s important to triage patients appropriately. Not every back pain sufferer needs to see a spine surgeon, or even a physician, right away. Yet our current system often funnels patients into expensive, sometimes unnecessary treatments. One study found that up to 50% of patients with chronic low back pain are receiving inappropriate care that does not align with best practice guidelines. This includes unnecessary imaging, medication, injections, even surgery.

The key is getting people to the right level of care from the start. For many MSK issues, the first line of treatment should be a consultation with an expert like a physical therapist or physiatrist.

Third, effective MSK care doesn’t end with the initial treatment. Ongoing management is crucial to prevent the problem from recurring. Too often, patients are told, “See me in eight weeks, and we’ll see how you’re doing.” Instead, patients and their clinicians need to maintain regular check-ins to monitor progress and adjust treatment as needed. It also involves educating individuals about self-management techniques and empowering them to take an active role in their recovery. Patients who aren’t improving after a week or two should be reevaluated. Unlike many health challenges, the MSK crisis is eminently fixable. Our experience shows that healthcare costs related to MSK conditions can be significantly reduced — often by double-digit percentages — by following a few basic principles. And these improvements in direct healthcare costs don’t even account for the considerable gains in quality of life. Simply put, the tens of millions of Americans with MSK conditions don’t have to “tough it out.” But they don’t necessarily need an MRI right away, either.

What they do need is for their employers — especially the large companies that design their own health plans or exert considerable influence over third-party insurers’ coverage decisions — to adopt a smarter approach to the problem.

Dr. Joel Press is the physiatrist-in-chief at the Hospital for Special Surgery in New York City and a professor of rehabilitation medicine at Weill Cornell Medical College. Salon.