Friday, December 28, 2012

A Soaring Burden of Musculoskeletal Pain

Musculoskeletal PainSurprising new data and ongoing initiatives highlight that increasing pain and disability associated with musculoskeletal disorders may have reached pandemic proportions. Musculoskeletal diseases are the greatest cause of disability — topping the list in the United States and second only to mental and behavioral disorders worldwide — according to newly released reports. Back pain was found to cause the most disability worldwide, while osteoarthritis has shown the greatest increases in the last 20 years.

They newest study, Global Burden of Disease 2010, published in The Lancet December 15, 2012 [available here], is the first comprehensive research into the worldwide impact of all diseases and risk factors. Among other findings, researchers conclude that musculoskeletal (MSK) conditions such as arthritis and back pain affect more than 1.7 billion people worldwide and have the 4th greatest impact on the overall health of the world population, considering both death and disability. This burden has increased by 45% during the past 20 years and will continue to escalate unless action is taken.

This landmark study of the global burden of all diseases provides indisputable evidence that MSK conditions are an enormous and emerging problem in all parts of the world and need to be given the same priority for policy and resources as other major conditions like cancer, mental health, and cardiovascular disease. The Global Burden of Disease 2010 project was led by Professor Christopher Murray, Institute for Health Metrics and Evaluation, Seattle, Washington, and involved researchers from around the world. Here are some key facts:

  • Musculoskeletal conditions include joint diseases such as osteoarthritis and rheumatoid arthritis; back and neck pain; osteoporosis and fragility fractures; soft tissue rheumatism; injuries due to sports and in the workplace; and trauma commonly related to road traffic accidents. They cause pain, physical disability, and loss of personal and economic independence.

  • Current estimates of people affected worldwide include: back pain 632 million, neck pain 332 million, osteoarthritis of the knee 251 million, and other MSK conditions 561 million [all numbers rounded].

  • As a group MSK disorders cause 213% of all years lived with disability (YLDs), which is second only to mental and behavioral disorders that account for 22.7% of YLDs. The leading cause of disability worldwide is low back pain contributing 10.7% of total YLDs, as compared with major depression contributing 8.1%.

  • Major contributors among MSK disorders are low back pain (83.1 million YLDs), neck pain (33.6 million YLDs), and osteoarthritis (17.1 million YLDs). Osteoarthritis of the knee accounts for 83% of the osteoarthritis category total.

  • Disability due to MSK disorders is estimated to have increased by 45% from 1990 to 2010 compared to a 33% average across all other disease areas. Osteoarthritis is the fastest increasing major health condition, which relates to aging of the global population, increased obesity, and lack of physical activity.

  • Disability due to MSK conditions can be effectively prevented by currently available interventions, such as accident prevention, modern treatment of arthritis and injuries, and by rehabilitation. The growing burden can be controlled if a high priority and ample resources are provided to ensure access to these interventions.

In the United States, a nationwide network of organizations has been working on the U.S. Bone and Joint Initiative (USBJI), which provides a forum for all stakeholders concerned with musculoskeletal health, raises the profile and priority of bone and joint health and disease prevention, and supports the advancement and expansion of musculoskeletal care and research through data dissemination, awareness-building programs, education initiatives, and advocacy [see website here]. Data on the prevalence of MSK disorders in the U.S. is published in their report, The Burden of Musculoskeletal Diseases in the United States: Prevalence, Economic and Societal Cost (2nd Edition). [document here]. Here are some key facts regarding the burden of MSK disease in the U.S.:

  • In the 2008 National Health Interview Survey (NHIS), musculoskeletal conditions were reported by more than 110 million adults, and more than 1 in 4 persons in the U.S. has a MSK disorder requiring medical attention.

  • Annual direct and indirect costs for bone and joint health are $849 billion — 7.7% of the gross domestic product.

  • Research on MSK disorders currently represents less than 2% of the U.S. National Institutes of Health budget, while the burden of musculoskeletal conditions is expected to escalate in the next 10 to 20 years due to the aging population and sedentary lifestyles.

  • MSK disorders and diseases are the leading cause of disability in the United States and account for more than half of all chronic conditions in people over 50 years of age.

  • More research is urgently required if health and economic burdens are to be contained or lowered.

According to this report focusing on the U.S., and using 2008 census data, musculoskeletal conditions top the list in terms of the prevalence of self-reported primary medical conditions among persons aged 18 and over — or an age-adjusted prevalence rate of ≈48%. This is followed by emotional disorders (prevalence rate ≈35%), circulatory system disorders (≈30%), respiratory disorders (≈24%), and migraines/severe headaches (≈12%).

In sum, the impact of MSK disorders on individuals, families, and society is colossal. Yet, these conditions are not among the top 10 diseases funded by research, primarily due to the low mortality from these compared with other severe health conditions. However, it must be considered that the morbidity costs of MSK disorders are quite significant, because these disorders restrict activities of daily living, cause lost work days, and are a major source of lifelong pain.

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