Based on the numbers involved, I think that back pain could form it’s own nation. It has a large community of people that are speaking the same language and are bound by common factors. There is also a rather large fiscal component that binds the community together.

We could call this new independent nation Backpainia (for lack of a better name). Maybe it could start as the 51st state of the US, and then seek its independence from the tyranny of, oh, lobbyist-driven health care.

But take heed, resolute citizens of Backpainia. Revolution is taking place throughout the world. Be it Egypt, Libya, or any of a plethora of nations, change is upon us. Something is also amiss in Backpainia – perhaps it is the next nation in need of a revolution?

The research data and socioeconomics of this nation explain everything.

First of all, Backpainia has a large population. The current census would indicate that anywhere from 50 to 80% of the US population experience back pain at some point in their lives, and 40% will experience back pain in any one year. This amounts to about 31 million Americans that are afflicted with low back pain at any given point in time. For reference, that is slightly larger than the population of Iraq, putting it #39 in the world. That’s a lot of people residing in Backpainia.

Every nation has a Gross National Product. Backpainia would be a nation with a healthy GNP. The current estimated costs of back pain in the US exceed $170 billion annually. Chronic low back pain patients consume 80% of the total costs related to this market. Studies have indicated that U.S. spending on diagnosis and treatment of spinal disorders increased 65% from 1997 to 2005.

In a study from Duke University published in Spine in 2004, which looked at back pain data from 1998, it was found that patients suffering from back pain consume more that $90 billion annually in health-care expenses. Remember, that was data from 1998.

The lead researcher of the study, Xuemei Luo, noted that "To put these expenses in perspective, the total $90 billion spent in 1998 represented 1 percent of the U.S. Gross Domestic Product (GDP)". It was also noted that "significant health-care savings could be achieved if this population of patients received more cost-effective and targeted treatments."

A GNP of $170 billion for the nation of Backpainia would be significant. Again, as a reference, that would have Backpainia ranking as the #35 country in the world for Gross National Product. Even if you use some conservative figures published by the Journal of the American Medical Association, it would still rank #51. That is some pretty significant dollars and cents.

Then we can look at the common language and traditions that seem to have evolved within this nation. The key characteristics in this population are recurrence and over-utilization.

If you do have an episode of back pain, based on the research, anywhere from 50 to 69% will still have symptoms at one year. If you are fortunate enough to get over your episode, 45 to 72% of people will have recurrences within the year.

There is a typical pattern of events and traditions in Backpainia. The resident of Backpainia goes to the doctor. The doctor immediately sends the patient for x-rays or MRI, at which point the doctor almost always finds a herniated disc. The patient is then told that this may eventually require surgery. The patient may be inundated with fear.

The research indicates consistently that 70% of asymptomatic people have disc herniations. There is little to no proof to suggest that an asymptomatic disc herniation will ever become a symptomatic one requiring surgery.

The US is #1 in the world in back surgeries, and #1 in the world in failed back surgeries. More than 20,000 lumbar spinal fusions are performed annually in the United States. There are eight times as many spinal surgical procedures performed in the United States (per capita) as in Britain. There is also a direct relationship between the number of spinal operations performed in any one geographical area and the number of orthopaedists and neurosurgeons that practice in that same area. That being the case, the likelihood of having surgery prescribed for you is related more to the demographics of your locale than it is to anything else. Poor residents of Backpainia.

And while we're at it - for those who want more numbers - the cost of a spinal fusion comes in around $45,000. As for failed spinal surgeries, the numbers are staggering as well - a cost of $2 billion per year.

What the citizens of Backpainia rarely know is that there are many evidence-based clinical guidelines (“guide” lines, not “rules”) that would strongly suggest that MRI and x-rays should not be the first line of defense in the assessment of back pain. These same guidelines help patients and doctors do a better job of assessing and treating the problem, and favorably impact the overall costs incurred. So why do they continue to be performed? Because the physician can do them, and the patient is convinced they need them. And neither answer is necessarily correct.

Back pain – a health problem on which we spend billions of dollars, apply a lot of useless placebo-driven treatments, and on which we foster even more consumer misinformation. The citizen of Backpainia is under tremendous socioeconomic stress, I would suggest. Back pain could, literally, become it’s own nation – one nation under pain, indivisible.

Backpainia should revolt. Surely the population must be getting a little restless at this point?

Photo credits: ::: Radar Communication :::