Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Pushing through the Pain the Annual Health Care Cost of Lower Back Pain in the U.S. Is $86 Billion, Making It One of Costliest Conditions in American Medicine

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Pushing through the Pain the Annual Health Care Cost of Lower Back Pain in the U.S. Is $86 Billion, Making It One of Costliest Conditions in American Medicine

Article excerpt

After he'd battled lower back pain for three months with hot showers, analgesic heat rubs and heating pads, it finally happened. Chris Roth awoke one morning barely able to move.

This was a huge problem for Mr. Roth. As owner of Steel City Ballroom in Mt. Lebanon, he teaches the trademark hip-shaking and body-twisting steps of ballroom dancing. "I canceled my lessons," said the 44-year-old Bethel Park resident. "I'd had back pain but not like that. This was the most extreme pain. That's when I couldn't push through it."

Fortunately for Mr. Roth, Anthony Delitto was a student. The chairman of the University of Pittsburgh department of physical therapy in the School of Health and Rehabilitation Sciences offered to help.

In his office, Mr. Delitto analyzed Mr. Roth's posture and how he walked to figure out the potential source of his pain. Then he had him lie down on his back and cross his legs in a figure-four position. Then he pounced on him and rocked him back and forth a few times. They heard a pop. The pain vanished. The hip was realigned. Back to the ballroom.

But Mr. Roth's efforts to continue dancing throughout the pain actually represents a new approach to treating lower back pain. Don't shut down. Remain active. Push through the pain so it doesn't become chronic.

To study that concept, Patient-Centered Outcomes Research Institute has awarded the University of Pittsburgh $14 million over five years to lead a national trial to test whether a more aggressive European treatment can better prevent acute lower back pain from becoming a chronic condition in which the level of pain magnifies and is more difficult and expensive to treat.

Participants in the trial include Intermountain Healthcare in Salt Lake City, Johns Hopkins Hospital and Health System in Baltimore, the Boston Medical Center and the Medical University of South Carolina.

Mr. Delitto will lead the trial to test the European treatment against "usual care" in which the doctor decides on treatment.

"Certain patients are more inclined to worry that when their back hurts they are further harming it, causing them to become inactive," he said. "That can seriously impede recovery and cause further damage, leading to chronic back pain."

Lower back pain, especially with no signs of a fracture or muscle damage, makes it imperative that the person stay active, in shape and on the job. "Chronic lower back pain is clearly something we would like to avoid," Mr. Delitto said.

Fighting back

Intense lower back pain can stab like a knife when a person picks up a dropped pencil or lifts a child. Or it could be the swing of a golf club or a slip on the ice.

But once it occurs, acute lower back pain can flash periodically throughout the day and continue for weeks, months and even longer. If it extends beyond six months, the pain could become chronic. About 10 percent of those experiencing lower back pain end up with a chronic condition.

The annual health care cost of lower back pain in the United States is $86 billion, a Journal of the American Medical Association study reports, making it one of the costliest conditions in American medicine.

The Patient-Centered Outcomes Research Institute is a nonprofit, nongovernmental organization created through the Affordable Care Act of 2010. Its mandate is to improve health care by helping patients, caregivers, clinicians, employers, insurers and policy makers make more informed health decisions. It funds projects that compare the costs and effectiveness of treatment options.

In that context, the Pitt-based trial will compare the "usual care" approach against the European strategy, which involves a primary care physician and a physical therapist. …

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