The American Academy of Pain Medicine

The Cost of Pain to Business and Society Due to Ineffective Pain Care

• Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce
• Costs of Lost Productive Time
• The Cost of Diabetes
• Cost of Diabetic Neuropathy (DN) Patients
• Back pain exacerbations and lost productive time costs in United States workers
• Pain exacerbation as a major source of lost productive time in US workers with arthritis

The prevalence of pain has a tremendous impact on business, with an estimated annual cost of $61.2 billion in lost productive time. Studies show that most of the pain-related lost productive time occurs while employees are at work and is in the form of reduced performance. The cost of pain is an enormous burden on today's society, particularly to employers. Employers need a more concrete understanding of the costs from health conditions in their workforce and its impact on lost productive time. Employers need to demand better health care to common treatable pain conditions affecting their employees and businesses.(1)

The following statistics highlights the significant number of people in the US in pain and the impact of business and society (2): At any given time:

• One in two Americans in pain
• One out of four has persistent or chronic pain
• Leading causes of recurrent or persistent pain affecting Americans are headache pain, back pain, and neck pain.
• About four in 10 Americans say pain interferes with their mood, activities, sleep, ability to do work or enjoyment of life. Two-thirds report interference with any one of these.

 
Lost Productive Time and Cost Due to Common Pain Conditions in the US Workforce

Almost thirteen percent of the total workforce experienced a loss in productive time during a two-week period due to a common pain condition: (1)

• 5.4% for headache
• 3.2% for back pain
• 2.0% for arthritis pain
• 2.0% for other musculoskeletal pain

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Costs of Lost Productive Time

Of the lost productive time (LPT) of $61.2 billion, the majority (76.6%) of the lost productive time was explained by health-related reduced performance while at work and not work absence. (1)

Costs that were not included:

• Costs from dental pain, cancer pain, gastrointestinal pain, neuropathy, or pain associated with menstruation.
• Did not account for pain-induced disability that leads to continuous absence of one week or more.
• Did not consider secondary costs from other factors such as the hiring and training of replacement workers or the institutional effect among coworkers.
• Underestimating the current lost productive time among those with persistent pain problems (ie. chronic daily headache)

The study states: "The opportunity for employers can be defined by the gap between lost productive time due to pain given current use of treatments and lost productive time due to pain given optimal use of treatments. The magnitude of this gap is difficult to quantify. Certainly, its aggregate economic burden, as estimated in this study, is enormous, but we cannot state how much of the burden can be mitigated. National survey data that provide detailed data on use of treatments are limited. Of the common pain conditions, sufficient details have only been reported on migraine headaches. Recent data indicate that only 41% of individuals who have migraine headaches in the US population ever receive any prescription drug for migraine." (1)

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The Cost of Diabetes (3)

Almost 17.5 million people in the U.S. have been diagnosed diabetes according to a 2007 study.(3)

For those diagnosed with diabetes:

• $2.6 billion of indirect costs include increased absenteeism
• $20.0 billion reduced productivity while at work for the employed population
• $.08 billion reduced productivity for those not in the labor force
• $7.9 unemployment from disease-related disability
• $26.9 lost productive capacity due to early mortality

Estimated national burden of diabetes is likely to exceed the $174 billion*

*This figure is an estimate because it omits the social cost of intangibles such as pain and suffering, care provided by non-paid caregivers, excess medical costs associated with undiagnosed diabetes, and diabetes-attributed costs for health care expenditures categories omitted from this study.

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Cost of Diabetic Neuropathy (DN) Patients (4)

• The total annual direct costs of DN and its complications in the U.S. were $4.6-13.7 billion in 2001
• Patients with DN had significantly higher total medical costs than individuals with diabetes but no DN
• It has been shown that more than one quarter of total direct costs for diabetes in the U.S. can be attributed to DN
• The indirect costs of DN, including missed days of work and decreased productivity, are a considerable component of total costs
• Recent research suggests that DN symptoms cause workers to lose approximately $3.65 billion per year in health-related lost productivity.

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Back pain exacerbations and lost productive time costs in United States workers (5)

• Back pain (BP) in workers 40 to 65 years of age costs employers an estimated $7.4 billion/year.
• 71.6% of this cost is due to workers with BP exacerbations
• 42.6% of all workers reported BP exacerbations, even though BP prevalence is associated with demographic factors.
• The 2-week prevalence of BP was 15.1%; with 42% of workers with back pain (BP) experienced pain exacerbations
• Workers with exacerbations reported more days with BP than those without exacerbations.
• Workers with exacerbations were significantly more likely than those without such exacerbations to report activity limitation (88.4% vs. 60.7%; P < 0.0001) and BP-related lost productive time (22.1% vs. 13.0%; P = 0.0259).

CONCLUSIONS: Workers with BP exacerbations account for a disproportionate share of the cost of BP-related lost productive time.

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Pain exacerbation as a major source of lost productive time in US workers with arthritis (6)

• The estimated annual lost productive time (LPT) cost from arthritis in the US workforce, ages 40-65, was $7.11 billion
• 65.7% of this cost attributed to the 38% of workers with pain exacerbations
• Pain exacerbation occurred among 38% of participants with arthritis
• Workers with pain exacerbations were significantly more likely to have higher WOMAC scores (38.6 versus 29.6; P = 0.0041) and report arthritis-related LPT (24.4% versus 13.3%; P = 0.0118) than workers without exacerbations
• Among those with LPT, average LPT did not differ (4.1 hours per week) between persons with and without exacerbations

CONCLUSION: Workers with arthritis pain exacerbation account for a disproportionate share of the arthritis-related LPT cost. Stratifying workers for appropriate treatment management based on pain exacerbation status could significantly decrease arthritis-related LPT and offer employees and employers an effective return on health care use.

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