Chronic Spinal Pain and Financial Worries in the US Adult Population

Haiou Yang, PhD; Scott Haldeman, DC, MD, PhD, FRCP(C), FAAN


Spine. 2020;45(8):528-533. 

In This Article

Abstract and Introduction


Study Design: Epidemiological study based on cross-sectional data of a representative sample.

Objective: To determine whether financial worries are associated with chronic spinal pain in the US adult population.

Summary of Background Data: This study used data from the US 2015 National Health Interview Survey. The sample size was 33,672 and the study population is defined as aged 18 to 85 years.

Methods: To account for the complex sampling design, the Taylor linearized variance estimation method was used. Spinal pain was defined in two ways: chronic low back pain and neck pain, chronic low back pain and/or neck pain. Eight types of financial worries were assessed: paying monthly bills, maintaining standard of living, credit card payments, paying rent/mortgage/housing costs, medical costs for healthcare, money for retirement, medical costs of illness/accident, and paying for children's college.

Results: Different types of financial worries were significantly associated with chronic spinal pain, controlling for demographic characteristics and socioeconomic status. These worries included paying monthly bills (odds ratio [OR] 2.5), maintaining standard of living (OR 2.5), credit card payments (OR 2.2), paying rent/mortgage/housing costs (OR 2.2), medical costs for healthcare (OR 2.2), money for retirement, (OR 2.3), medical costs of illness/accident (OR 2.2), and paying for children's college (OR 1.4).

Conclusion: This study shows that financial worries were significantly associated with chronic spinal pain. Financial worries may be important to be taken into consideration by clinicians managing patients with spinal pain. More future research is needed to explore the association between financial worries and spinal pain.

Level of Evidence: 3


Spinal pain (low back pain and neck pain) is a pandemic medical condition. The annual direct costs of treating spinal pain in 2013 was reported as high as $87.6 billion in the United States, the third highest treatment cost among all the major health conditions, following diabetes and ischemic heart disease.[1] Spinal pain causes substantial functional, work and social limitations for individuals and families, as well as enormous economic costs for employers and the society.[2,3]

There has been is a growing body of research linking low socioeconomic status with higher incidence of chronic musculoskeletal pain.[4–6] Limited research has demonstrated a reversed association between chronic pain, especially chronic musculoskeletal pain, and socioeconomic status in adult populations in the United States[4] and Sweden.[7] Researchers from Switzerland identify an association between financial hardship and chronic pain[8] and Japanese scholars consider financial hardship as a risk factor for a new onset of low back pain.[9] Another group of studies suggests that financial hardship or financial worry may lead to psychosocial strain related to chronic pain.[5,10–13] However, the association between financial worry and spinal pain has been understudied.

The goal of this study is to explore whether financial worries are associated with chronic spinal pain in the US adult population.