When patients with painful back problems are also depressed, they have significantly higher healthcare costs than back-pain patients without depression, a US study suggests.
Getting treatment for both depression and back pain may reduce pain episodes and the economic burden, the study authors write in the journal Pain Medicine.
"Back pain is a big problem in our clinics, and we're seeing more and more admissions," said lead study author Dr Jawad Bilal of the University of Arizona College of Medicine in Tucson.
Overall, about two-thirds of adults experience low-back pain during their lifetimes, which makes it one of the most common patient complaints in hospitals and doctor's offices across the country, he said.
"We also know that depression can increase the sensation of pain," he told Reuters Health in a phone interview. "Those with depression may need to use inpatient and outpatient services more.
Bilal and colleagues analyzed data from a nationally representative US government health expenditures survey that also includes insurance claim information. The study team looked at spending between 2010 to 2012 on inpatient and outpatient services, as well as emergency room visits, prescription medications and home healthcare.
Among nearly 73,000 people in the analysis, 6,739 reported having painful back problems such as vertebral disc issues, and 1,310 of the people with back pain also had a depression diagnosis.
The research team found that back pain patients with depression had about US$13,000 in total health care expenses per year, as compared to US$7,500 for those without depression.
There was higher spending with depression across most types of services. For instance, inpatient costs were US$3,600 versus US$1,900, outpatient costs were US$4,400 versus US$2,900, prescription costs were US$3,500 versus US$1,500 and home health costs were US$470 versus US$140. Emergency room expenses didn't differ between the groups.
The study team did not have information on back pain severity, which could have influenced the depression in some patients, the authors note. Another limitation of the study is that it looked at a single point in time and cannot prove whether or how depression might have caused increased patient spending.
However, several factors could underlie this connection between depression, back pain and higher costs, Bilal said. Some patients who seek treatment for depression may be diagnosed with back pain earlier and be referred to specialists, which could increase costs. On the other hand, many back-pain patients may have depression but not receive treatment because it's not diagnosed. Biologically, depression could affect pain modulation mechanisms in the body, as well as immune system and inflammatory responses, and cause the pain to be more severe or frequent.
Overall, Bilal and colleagues recommend a multidisciplinary approach, including back pain specialists and psychologists to treat their patients, which could improve quality of life, disability and lifestyle habits such as exercise.
"It's tough to address this problem because it's so complex," Bilal told Reuters Health by phone. "Joining forces could reduce costs and increase patient satisfaction and happiness at the same time."
In future studies, Bilal and colleagues want to study whether healthcare costs change if someone seeks depression treatment, and whether it matters if the depression therapy is medication or cognitive behavioral practices.
"We can't say for sure, but treating anxiety and depression could improve your pain, reduce your stress and decrease hospitalisations," he said. "In the end, it's all about helping the patient feel better, and a lot of people ignore their mental health."
Previous studies of the dataset used by Bilal's team have also found a correlation between chronic back pain and rising costs, particularly among aging baby boomers, said Monica Smith, director of research for Life Chiropractic College West in Hayward, California, who wasn't involved in the study.
"It is important to understand the importance of integrative holistic approaches to successfully address both the physical health and mental health aspects of many health problems, especially in the area of pain management," she told Reuters Health by email.
"At a societal level, effective and cost-efficient health policy and regulation should prioritize integrative care within public programs such as Medicare and Medicaid, as well as in private insurance programs," she said.
SOURCE: https://bit.ly/2Rp1tiM Pain Medicine, online November 16, 2018.