Pain in the Neck
Chronic pain can be a real financial drain. A look at what your business can do to head off problems.
$550 billion—that’s the annual economic impact chronic pain has in the U.S.
Acute and chronic pain can lead to lost productivity and focus, increased absenteeism, lost wages and increased costs of disability and workers compensation for businesses. And, after decades of using narcotics as a primary treatment method, those costs have increased to include opioid dependence and other complications.
Today, physicians are exploring and implementing new ways to intervene or even prevent chronic pain and businesses are joining in to find ways to reduce their own costs and improve the health and wellbeing of their employees.
A Worsening Problem
Back and spinal pain tend to be the “bread and butter in pain management,” according to Eric Royster, MD, owner of Integrated Pain and Neuroscience. Lower back pain is second only behind the common cold as the top reason people schedule a doctor’s visit, according to healthcare consulting firm Advisory Board. An estimated 80 percent of Americans will suffer from lower back pain at some point in their lives, though it is most common for people ages 35 to 60.
Neck and joint pain are also common, including a perceived rise in cases of shoulder pain even in people who are not overly active, according to Benjamin Dichiara, DC, CCSP, sports chiropractor at Allied Chiropractic and Wellness.
Physicians and pain management specialists point to two key reasons why chronic pain has become more common: longer lifespans and an increasingly sedentary lifestyle. Due to healthcare and technological advances, people are living longer, but if they don’t take proper care of themselves, people are starting to “outlive their mobility,” says Dr. Dichiara.
Technological advances have also led to more jobs and leisure activities that revolve around televisions, computers and mobile devices, which means people are sitting for more hours of the day. Sitting causes pressure on the lumbar spine, which over time can turn into chronic pain, according to Allan T. Parr, MD, interventional pain management specialist at Premier Medical.
“They talk about sitting being the new smoking,” says Dr. Parr.
Chronic Pain Treatment Evolves
While opiates have helped many chronic pain sufferers live a more normal life, the dramatic increase in opioid prescriptions in the past few decades have had dire consequences, according to the Centers for Disease Control and Prevention:
• Opioid use may have actually worsened pain and functioning for patients.
• As many as 26 percent of patients prescribed opioids for chronic non-cancer pain become dependent on opioids.
• One out of every 550 patients prescribed opioids died from opioid-related causes after a median of 2.6 years following their first prescription.
“We’re getting some of the downsides of these opiates, whether it’s the respiratory problems, decreased immune system, increased risk of depression, or actually increased risk of pain without the improvement in function that we’re looking for,” says Dr. Eric Lonseth, interventional pain specialist at Lonseth Interventional Pain Centers.
As a result, doctors and pain management specialists have begun exploring alternative, complementary, interventional, and holistic treatments for pain management. Many are low-risk and non-invasive and can be used in combination with each other or other treatment methods:
• Alternative prescription medications, such as anti-depressants or anti-seizure drugs that can block pain reception;
• Neuromodulation, such as spinal cord stimulation or deep brain stimulation;
• Surgeries that require smaller incisions with less trauma and faster recoveries;
• Chiropractic manipulative therapy;
• Active release technique;
• Therapeutic stretching;
• Nerve entrapments;
• Joint injections;
• Epidural steroid injections;
• Psychological and behavioral modification therapy;
• Stem cell therapy, such as platelet rich plasma; and
• Weight loss, which relieves pressure from the joints.
“Pain management has gone from, ‘You have pain, just kind of live with it—here’s a bunch of pills to take,’ to now less invasive, higher-technology regenerative type of medicine to restore wellness and function,” says Chad Domangue, MD, manager of Cypress Pointe Hospital and manager of the Neuroscience and Pain Institute. “It’s looking at the body as a whole [and] that multi-disciplinary approach that makes the most sense.”
Pain Comes at a Cost
Businesses bear a large brunt of that $550 billion cost. An Institute of Medicine report estimated the annual value of lost productivity due to pain in 2010 ranged between $297.4 billion and $335.5 billion. That total was based on three estimated factors: absenteeism ($11.6 to $12.7 billion); lost work hours ($95.2 to $96.5 billion); and lower wages ($190.6 billion to $226.3 billion).
Chronic pain scenarios vary based on the nature of a business. Employees could develop acute or chronic pain from prolonged sitting, such as in office settings or for drivers; prolonged standing with few breaks, such as in service and retail industries; repetitive movements, such as in construction; or from lifting or operating heavy products or equipment, such as in manufacturing and delivery.
What Businesses Can Do
Pain management and prevention programs may seem out of budget, but the potential costs businesses face due to chronic pain make the issue difficult to ignore.
Businesses can partner with local hospitals and interventional pain management facilities to assess working conditions and develop programs suited for their particular environment and operations. Being mindful of employees’ complaints related to pain, however minor, can clue management in to possible problem areas.
Businesses commonly incentivize self-care to promote employee health, wellness, and productivity. For pain management and prevention, businesses can provide reminders or incentives for employees to take regular breaks, which allows them to stretch and change bodily positions. Or businesses can incentivize engagement in physical activities and movement, such as gym memberships or companywide outings or health challenges.
“You want to put the money on the front end and encourage your employees to do the proper things, because in the long run, you’re going to save money.” - Chad Domangue, MD manager of Cypress Pointe Hospital and the Neuroscience and Pain Institute.
Ergonomic specialists can assess workstation setups and office equipment, such as whether a computer monitor is at the right height to prevent strain on the neck. Some businesses have adopted standing desks or desks that employees can adjust in height to accommodate both sitting and standing.
For employees engaged in heavy lifting, management can train the employees in proper body mechanics, offer weightlifting belts, or invest in forklifts, hand trucks, or other related equipment. Activity modification can also solve pain issues from repetitive movement, such as finding different ways to turn a wrench or taking regular breaks to stretch.
“You want to put the money on the front end and encourage your employees to do the proper things, because in the long run, you’re going to save money,” says Dr. Domangue.
Management can also encourage employees complaining of any type of pain to seek medical advice right away rather than allowing the pain to worsen over time and become chronic. That can be through the employee’s own healthcare providers or a pain management specialist who management brings into the office for an assessment.
“I own a big business, I run a hospital, and I get it—you just don’t have the time,” says Dr. Domangue. “But until you have a couple of workers get injured and you see the amount of money that the lost wages and disability generate, it’s so much larger than anything you would do to prevent those things from happening.”
The Importance of Prevention
To avoid the need for pain management altogether, prevention and addressing issues early on are critical. Both individuals and businesses can get involved in identifying and implementing measures for preventive care. Prevention reduces the likelihood of developing chronic pain over time or allowing an acute pain issue to become chronic.
“A tremendous number of patients we see coming in with spine complaints are that 45-year-old who’s been letting themselves go for 20 years,” says Dr. Royster. “They’ve got a family, they work a lot, and all of a sudden, they’ve not been taking care of themselves, and things start to fall apart. […] I think we’ll start to realize that the longer we let these chronic pain problems go untreated, the more likely it is to become a long-term problem and a truly chronic condition.”
The Dangers of Sitting
While it might seem like sitting all day would be less harmful to the body than standing, studies show that the opposite might be true. According to a 2015 study published in the Annals of Internal Medicine, the average person spends more than half of their waking hours sitting, and prolonged sitting was correlated with higher risks of dying from all causes.
That was even among people who exercised regularly, though people who performed little to no exercise showed even more significant negative effects. Another study of older women, published in the American Journal of Preventive Medicine in 2014, found the same results.
Why is prolonged sitting so harmful to the body?
Dr. Dichiara offers a physiological explanation:
“Muscle movement patterns are developed over time, the most common being if we’re sitting at a computer or desk all day long. Our shoulders tend to round forward just because of our posture. Then, as a result, the pecs and the anterior muscles contract and shrink. The upper back and neck have to work harder against those muscles, so an imbalance develops.”
A study published in the Asian Spine Journal last year found that pressure on the lumbar spine is actually higher when sitting than standing, which Dr. Parr notes could lead to chronic lower back pain.
“We just weren’t meant to sit eight hours a day at a desk,” says Dr. Royster, “and people pay for it.”