The impact of musculoskeletal pain on healthcare spend

Musculoskeletal pain is on the rise, along with its impact on healthcare expenditure.

Associated with more than half of chronic pain conditions, musculoskeletal conditions encompass a broad spectrum of disorders affecting the bones, muscles, joints, ligaments, and tendons. From arthritis to fractures and sprains to strains, these conditions can range from mild discomfort to debilitating pain, significantly impacting individuals’ quality of life.

Nearly 126.6 million Americans reported dealing with at least one musculoskeletal issue in 2020 alone. Given that this represents a substantial portion of the population, the financial ramifications of providing care for musculoskeletal pain are unsurprising. Data reveals that musculoskeletal conditions account for a significant portion of healthcare spend.

With costs projected to escalate further, it will become increasingly important to understand the drivers behind musculoskeletal pain and its associated costs and to explore strategies to mitigate the financial burden.

3 ways musculoskeletal pain is driving healthcare costs 

1. Many receive unnecessary surgery in lieu of more conservative treatment

Despite advancements in medical interventions, many high-cost treatments for musculoskeletal pain––most commonly surgeries––are often unnecessary or ineffective. While beneficial when appropriate, many times there is a lack of sufficient evidence to support their use instead of non-surgical interventions.

Consider spinal surgery or shoulder impingement surgery: 20 to 40% of low back surgeries fail to alleviate low back pain, with even higher rates of failure in shoulder impingement surgeries. These surgical interventions are frequently used when less invasive options could suffice, leading to inflated healthcare expenditures, recurrent health issues, and additional interventions.

Not only are these surgeries among the most expensive interventions––contributing to higher healthcare costs all around––their costs add up in the long run. An ineffective surgery might necessitate follow-up surgeries or extensive physical therapy. For example, in 2015, average knee surgery cost was around $16,000 at discharge. But in the following weeks, between inpatient and outpatient visits, physical and occupational therapy, visits to surgeons and other medical providers, and emergency room stays, patients paid an additional average of almost $9,000. When it comes to spinal fusions, the numbers are even more eye-popping: between 1998 and 2006, the total spend for revision procedures increased 535%.

But not all costs are related to surgery, facility use, or doctor visits. Given that orthopedic surgeons are the third most frequent prescribers of opioids in the U.S., there is a high potential for overexposure to these drugs, which can lead to opioid misuse and adverse drug events.

Thus, a value based care approach is essential to ensure patients receive appropriate care, thereby curbing unnecessary surgery rates and associated costs and ensuring positive outcomes down the line.

2. As the population ages, so does the number of musculoskeletal conditions

The changes wrought on aging bodies exacerbate the prevalence of musculoskeletal issues. As individuals grow older, physiological changes in their bones, muscles, and joints contribute to increased susceptibility to musculoskeletal pain in the low back, knees, and hips, and more.

The skeleton supports the body, and as its owner ages, the protective disks between its bones lose some of their gel-like cushion. Loss of bone density and mineral content leads to more fragile, brittle bones, while wear and tear on joints and cartilage becomes more commonplace.

All of these changes, while normal, lead to a greater susceptibility to broken bones, musculoskeletal pain, inflammation, limited mobility, loss of energy, and decreased motor function. 

As people age, certain musculoskeletal issues become more prevalent, leading to conditions like osteoarthritis and degenerative disc disease. These age-related changes contribute to the development of chronic pain and stiffness in the low back, knees, and hips, making everyday tasks challenging and reducing overall mobility.

Additionally, decreased muscle mass and strength with age can exacerbate musculoskeletal conditions, as weakened muscles may struggle to support and stabilize joints effectively. And age-related comorbidities such as chronic obstructive pulmonary disease (COPD) and congestive heart failure can compound musculoskeletal issues, amplifying the severity of symptoms and impairing quality of life for older adults.

Addressing the unique needs of older individuals requires tailored interventions aimed at managing pain, improving mobility, and promoting overall musculoskeletal health to enhance their functional independence and well-being.

3. Poor ergonomics and decreased physical activity during the pandemic contributed to a rise in musculoskeletal pain 

The COVID-19 pandemic ushered in a new era of remote work, with a 10% rise in employees working from home over the first year of the pandemic. Many of those workers found themselves suddenly working from their kitchen tables or couches, or scrambling to put together makeshift home offices.

The suboptimal ergonomics of these set-ups were manifold: prolonged sitting in non-ergonomic setups led to discomfort, exacerbating existing musculoskeletal conditions and precipitating new ones. Poor posture in non-ergonomic chairs or desks can also contribute to decreased circulation, head and neck pain, and fatigue, all of which can compound MSK conditions.

Furthermore, one legacy of the pandemic has been an increase in sedentary lifestyles, even further compounding MSK issues. With one out of five employees still teleworking, we can expect this issue to persist.

Given that there is a direct correlation between prolonged sitting and musculoskeletal pain, addressing ergonomic shortcomings and promoting physical activity is essential to mitigating MSK-related healthcare costs. 

How a center of excellence (COE) program can help address musculoskeletal pain and conditions

Implementing a healthcare center of excellence (COE) program like Carrum Health offers a viable solution to combat escalating MSK costs. By adopting a value-based approach that prioritizes patient outcomes over volume-based reimbursements, COE programs incentivize less-invasive treatments and discourage unnecessary surgical intervention. These programs can also reduce readmissions and complications, meaning lower costs in the long term. A value-based COE model connects patients with the highest quality providers and empowers those providers to recommend optimal treatment pathways, thereby optimizing resource utilization and improving patient satisfaction.

The surge in musculoskeletal costs poses significant challenges for employers and benefits consultants alike. Understanding the drivers behind this trend, from overtreatment to demographic shifts and pandemic-induced lifestyle changes, is crucial in devising effective mitigation strategies. By embracing innovative solutions such as COE programs and prioritizing preventive measures, stakeholders can navigate the complex landscape of MSK care costs while ensuring optimal health outcomes for all.

The information contained on this page is for informational purposes only. No material is intended to be a substitute for professional medical advice, diagnosis, or treatment.