Socioeconomic Factors Associated With Not Receiving Treatment for Chronic Severe Back Pain

A new study of adults in the United States with chronic severe back pain showed that nearly 21 percent did not receive treatment for at least 3 months and that socioeconomic factors played a role. The cross-sectional study, which was recently published in The Journal of Pain, was conducted by researchers from the Université de Montréal and the National Center for Complementary and Integrative Health. 

Chronic pain is a long-term condition that interferes with daily activities. Several challenges to accessing treatment have been widely acknowledged, including provider attitudes and training, insurance coverage, cultural attitudes of patients, and geographic and regulatory barriers. But little is known about people who do not receive treatment. This study identified the differences in people with chronic severe back pain who did and did not receive care for their chronic severe back pain. 

The researchers used data from the 2019 National Health Interview Survey (NHIS), a nationally representative, population-based study, and applied Andersen’s Behavioral Model for Health Care Utilization. The model contains three main categories: predisposing factors (e.g., age, sex, race), enabling factors (e.g., income, home ownership) and perception of need (e.g., number of pain conditions).  

To meet the criteria of chronic severe back pain, study participants had to experience back pain most or every day of the week and report that the pain bothered them “a lot.” Of the 31,997 adults who participated in the 2019 NHIS, 2,925 people were identified as having chronic severe back pain. Among those respondents, 20.8 percent had not received any treatment for their pain in the previous 3 months compared to 79.2 percent who did. 

The researchers found that certain socioeconomic factors were highly associated with not receiving treatment for chronic severe back pain. In addition to lacking health insurance, living near or below the poverty level, and having less than a high school education, notable factors included not being a single parent, being male, regional differences, or having heart disease.

The researchers acknowledged that other studies have found that financial considerations can reduce access to health care or health insurance, while lower education levels may be associated with lower levels of health literacy and lower access to care. Others have found that single mothers were more likely to report poor health and more likely to seek care than married mothers, while women typically are more inclined to seek medical care than men. The researchers noted that recent data shows that people living in the South tend to have the highest pain scores in the United States, and additional research indicates there may be fewer physicians and limited resources in this region compared to others in the country. Additionally, people with heart disease may not receive treatment for chronic severe back pain due to concerns by their health professionals that pain medications could possibly harm the patient.

The researchers concluded that timely and personalized treatment for chronic back pain is essential to reduce long-lasting pain and disability, and the results of this study amplify the need to implement solutions to reduce barriers to care.