Could "Out-of-the-Box" Thinking be the Future Cure for Low Back Pain Disability Claims?

Steve Dorn, SVP Strategic Product Group, FINEOS

According to the Centers for Disease Control, 14 percent of all new visits to primary care physicians are the result of lower back pain. The CDC also states that 2.4 million adults in the United States suffer chronic back pain and another 2.4 million suffer temporary back pain.  In fact, an estimated 80% of the adult population will have back pain at some point in their life and the pain associated with back, joint and muscle conditions are the leading cause of disability in the US.  It’s a problem that will only get larger as the average age of the US population continues to increase.  For the Social Security Administration, almost 35% of all of their disability claims are due to these conditions and those numbers are steadily growing.

The conventional approach to back pain treatment will usually end in a surgical alternative.  An estimated 38 to 50 billion dollars are spent yearly for the surgical treatment of lower back pain in the United States (PRWEB) May 29, 2013)).  The surgery to address this problem will cost on average between 10 and 85 thousand dollars and yield varied results.  If we could find a cheaper and more effective alternative to the surgical solution, the cost savings to Insurance Companies and the Government would be significant.

If you want to find new solutions, you have to think “outside the box”.  Sometimes you have to get outside the box you’re in.  We used to think that spicy food, acid, and stress were the major causes of ulcers that affect twenty five million Americans, but we now know that nine out of ten ulcers are caused by H. pylori and can easily be cured with the right course of antibiotics.  It was that kind of out-of-the-box thinking that led a group of Danish researchers to look for a link between back pain and infections from bacteria.   The study published in the European Spine Journal, covered  in Bloomberg (May 7th) and presented in London supported previous research that has linked some cases of chronic back pain to bacterial infection. The back pain is caused by an infection of Proprione acne bacteria inside the affected spinal disc. The bacteria normally live in hair follicles, on the gums and inside cheeks and may enter the bloodstream after the teeth are brushed and travel into the damaged disc.  As many as 4 in 10 cases of chronic lower back pain are probably caused by bacteria, and treatment with antibiotics may cure them.  In the study, as many as 80 percent of the participants with persistent back pain following a herniated disc and swelling in the spine reported an improvement after taking antibiotics three times daily for 100 days.  The team of scientists said the discovery merits the establishment of a new disease category, Modic-related low back pain. The group devised a diagnostic test using MRI scanning and treatment with Bioclavid, a generic version of GlaxoSmithKline Plc (GSK)’s Augmentin.

While there is still more evaluation underway, the findings give us optimism that we still have a long way to go in applying innovative medicine and therapies to  reduce claim severity and duration.

If you’re a FINEOS Claims customer you already know how easy it is to report on back claims to see how much of an impact these claims could have on your book of business.  You can also establish a new screening collection process to target these opportunities for your business today and start saving money on your future claims.  If you’re not a FINEOS Claims customer, lets us help you get out of the box you’re in and experience our innovative solutions and thinking.

For more information please see the original article published in Bloomberg.

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