I’ve had a niche practice focussing on chronic pain for a couple of decades now, and one of the things I notice is that people with chronic pain tend to delay seeking care for common ailments like back pain. “It’ll just go away by itself” is a common attitude. Or they seek inexperienced and poorly skilled practitioners initially in the hope of saving a few bucks (and generally ending up with a less than optimal result – the “get what you pay for” scenario), only to give up on professional care until things become unbearable. As an aside,
Cheap is not necessarily what you want when it comes to your most important asset, your health!
Having grown up with the principal that “if you don’t have your health, you don’t have anything”, I’ve been a bit puzzled why anyone would delay seeking care or simply convince themselves that care for any kind of problem is unnecessary. The problem when issues are allowed to become chronic is that that they tend to spread and get worse and worse. Often when I take a patient’s history, I’m left thinking “how much quicker and easier this would have been if only I’d seen you at the beginning of this mess”.
This prompted me to take look at what research says the impact of delayed care is on musculoskeletal pain. This type of research analyses large databases from insurance providers, hospitals or other large institutions to identify general patterns. It includes not only the cost of professional services, but medication, injections, imaging, surgery and importantly the cost of time off work (inability to earn a living). Other studies examine if the treatment was helpful (ie does it reduce your pain?). Here’s a quick summary:
Is professional care effective? It turns out that Physiotherapy is effective in reducing pain including for older adults with back pain (Rundell et al 2015). Those patients who used Physiotherapy care had less pain and better functional outcomes than those who did not. So seeking care (esp. world class care!) is likely to result in improvement.
Does it matter where your pain is? In a major review of the efficacy of Physiotherapy in treating all types of chronic pain in all regions of the body, Physiotherapy was shown to be effective in almost every study included in a large systematic review (Burge et al 2016). So it doesn’t matter where your pain is, seeking care is likely to help.
If you do nothing for your spinal pain, what typically happens? It turns out that most people have recurrence or develop chronic pain (Da Silva et al 2019) (for more see my blog here). Why? Because the causes are still present! Rest and medication simply allow things to settle in the short term but make no long-term difference. So failing to seek care is most likely to result in chronicity and a gradual worsening of your symptoms (which is a reasonable expectation if nothing is done to address the underlying causes).
“It’ll just get better by itself” is an attitude based more on hope than reality.
What’s the financial cost of delaying professional care? The cost of seeking Physiotherapy care early (in the first 3-7 days of pain) vs seeking care late (1-3 months later) is massive. According to a large study of over 46,000 patients with low back pain of all causes in New York state, those receiving early Physiotherapy care consistently paid less for their health care (less than $3000 USD in 2019 for those seeking immediate physiotherapy care vs >$6000 for those seeking care 30-90days later). The early care group used less medication, had fewer scans and less time off work, not to mention less than half the bills!
What changes occur to my body if I just put up with pain? If you allow the pain to go on and become chronic, there is a very well documented deterioration in muscle function, with atrophy, scarring and fatty infiltration in chronic low back pain patients (this means chronic inflammation results in the back muscles turning into scar tissue and fat) (Matheve et al 2023) (for more information about this see my blog here). Given how critical muscle function is for a healthy spine, it is reasonable to conclude that the likelihood of recurrence of back pain is greater once this occurs. Conversely, this process is relatively easy to prevent if care is sought immediately and the muscle atrophy and weakness prevented. Moreover, there is good evidence to show this, with restoring muscle function shown to dramatically reduce the chance of recurrence or chronicity (Hides et al 2001).
Taken together, these findings make it clear that:
doing nothing in most cases leads to recurrence, chronicity, progressive deterioration in the muscles supporting the painful areas, worse pain and higher financial costs, including more time off work / sport and a lower quality of life.
Conversely, early care has clear benefits in preventing deterioration in muscle function, reducing overall cost, and improving pain and lifestyle.
Can you afford not to seek care early?
Wishing things will magically disappear by themselves, especially spinal pain, is just that – wishful thinking!
Action is required to change the outcome. Outcomes of professional care are better and less costly, especially in world class hands.
References:
Burge E et al (2016): Cost-Effectiveness of Physical Therapy Only and of Physical Therapy Added to Usual Care for Various Health Conditions: A Review. Phys Ther 96:774.
Da Silva T et al (2019): Recurrence of low back pain is common: a prospective inception cohort study. J Physiotherapy 65:159.
Hides J et al (2001): Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain. Spine 26:E243.
Liu X et al (2019): Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs. Phys Ther 98:336.
Matheve T et al (2023): The Role of Back Muscle Dysfunctions in Chronic Low Back Pain: State-of-the-Art and Clinical Implications. J Clin Med 12:5510.
Rundell ST et al (2015): Patient-Reported Outcomes Associated With Use of Physical Therapist Services by Older Adults With a New Visit for Back Pain. Phys Ther 95:190.
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