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
U.S. 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.
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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 $13,000 in total health care expenses per year, as compared to
$7,500 for those without depression.
There was higher spending with depression across most types of
services. For instance, inpatient costs were $3,600 versus $1,900,
outpatient costs were $4,400 versus $2,900, prescription costs were
$3,500 versus $1,500 and home health costs were $470 versus $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.
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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
hospitalizations," 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.
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