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


This study highlights an issue rarely discussed or considered in the literature on low back and neck pain: a particular form of psychosocial stress, that is, financial worries. This study indicates that close to one third of the US adults were very worried about one or more forms of financial worry. This finding is consistent with the data from the 2014 and the 2017 Stress in American Survey, recognizing money stress and uncertainty in healthcare as a major source of stress for Americans.[19,20]

This study shows that eight types of financial worries were significantly associated with low back and neck pain, including, paying monthly bills (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). These eight types of financial worries were also significantly associated with low back and/or neck pain, but with lower ORs.

In addition, this study demonstrates that increased degree of financial worries was associated with a higher likelihood of chronic spinal pain. Comparing with people not very worrying about financial issues at all, the likelihood of reporting both low back and neck pain increased as the numbers of worries increased, from 30% (one type of worry), 122% (two to three types of worries) to 178% (four to eight types of worries). A similar pattern was seen between the number of financial worries and low back and/or neck pain.

This study also shows that pain in two areas of the spine (low back and neck pain) is more closely associated with financial worry than pain in only one region of spine (low back and/or neck pain). This study suggests the importance of enquiring about pain in other regions of the spine in the clinical setting, when presented with a patient with low back or neck pain.

Increasing attention has been paid to cognitive behavioral therapy (CBT) that has demonstrated a statistically significant positive effect to reduce functional disability and pain catastrophizing.[21–23] The CBT has two components, the physical activity component and the psychosocial component. The psychosocial component of the CBT focuses on situational circumstances and maladaptive thoughts such as catastrophizing and poor understanding of spinal pain.[24,25] However, the situational circumstances or negative thoughts related to spinal pain have been understudied.[23,26–28]

Given the close association between financial worries and spinal pain, financial advisors could play a role in the CBT process by "integrating emotional, behavioral, relational, and economic aspects to promote financial health."[29,30] Perhaps referral to a financial advisor could be considered as a part of the psychosocial component of the CBT to address the financial worries of patients. This may or may not reduce the level of pain but would be likely improve the lives of people who are seeking care for spinal pain. This study may have an important implication for the future clinical trials of the CBT or other approaches in the management of spinal pain to identify financial worries as a type of negative thoughts that may relate to pain.

A limitation of this study is related to the cross-sectional nature of these data. It is not possible to conclude whether financial worries are contributors to spinal pain,[5,31,32] or that spinal pain causes increased financial worries perhaps due to disability or other associated psychological or behavioral factors.[7] There are also shortcomings within the NHIS database that limits the conclusions one can reach from this type of analysis. Discussion on the financial worry about children's college expense is also limited as it was impossible to exclude subjects without children or children who may not plan to go to college. In addition, it is important to note that the significant associations between financial worries and chronic spinal pain may be related to the large sample size of the data.

What is clear is that financial worries are very common in people with chronic spinal pain and that it would be worthwhile for health professionals and clinicians to ask about these issues and perhaps suggest ways to reduce the financial stress. This may not reduce the level of pain but would be likely improve the lives of people who are seeking care for chronic spinal pain.