American adults who use complementary health approaches to treat or manage pain spent an estimated $14.9 billion out-of-pocket on them, according to the 2007 National Health Interview Survey (NHIS). This amount accounts for 20‒25 percent of all out-of-pocket spending to treat or manage pain, including complementary and conventional care. The survey was conducted by staff researchers at the National Center for Complementary and Integrative Health (NCCIH) and RAND Corporation, and the findings appear in The Journal of Pain.
The NHIS annually interviews tens of thousands of Americans about their health- and illness-related experiences. In 2002, 2007, and 2012, NCCIH supported a supplement to the NHIS on complementary health approaches. Researchers used the 2007 NHIS data for this study because its design allowed them to calculate unbiased assessments of national out-of-pocket costs for a variety of complementary approaches.
The respondents for this study were 5,467 adults who had reported using at least 1 of 36 types of complementary health approaches in the past 12 months (for nonvitamin nonmineral dietary supplements, the time period was the past 30 days) and responded to followup questions about their expenditures on complementary practitioners, products, classes, and materials. The questions included which condition(s) they treated with each complementary approach, the number of visits they made to a complementary health practitioner, the number of purchases they made of complementary health products/classes/materials, and how much they spent on those visits and items.
The researchers examined 14 pain conditions to determine the total cost data for pain: arthritis, dental pain, fibromyalgia, gout, inflammatory bowel disease, jaw pain, joint pain or stiffness/other joint condition, lupus, regular headaches, rheumatoid arthritis, sprains or strains, back pain or problem, neck pain or problems, and severe headaches or migraines. Data on specific conditions were based on the top eight conditions.
Among the major findings were:
- The four pain conditions with the highest estimated out-of-pocket spending for complementary approaches ($13.7 billion total) were back pain, neck pain, joint pain, and arthritis.
- Back pain was the number one condition by far, at $8.7 billion out-of-pocket. This was more than one quarter the amount spent on all conventional health care for back pain ($30.5 billion, according to Medical Expenditures Panel Survey data). Most of the complementary approach spending for back pain―$4.7 billion―was for practitioner visits rather than dietary supplements.
- The order of spending levels by condition matched the order of frequency with which complementary approaches were used to address the 14 pain conditions. Thus, the primary driver of spending levels, the authors noted, seems to be frequency of use, not the varying per-visit or per-purchase out-of-pocket costs of one condition over another.
In addition, when the data were viewed on a per-person and per-condition basis, people with fibromyalgia spent the most out-of-pocket (an estimated $895 per year), while people with regular headaches spent the least ($568). People with fibromyalgia or regular headaches spent the most on visits to complementary practitioners, while people with sprains/strains spent the least on visits.
Their results, the authors note, may help shape research in complementary health, inform cost-of-illness studies, educate practitioners and policymakers, and increase knowledge about the economic impact of pain conditions and complementary approaches—as well as how the approaches are used and valued.
- Nahin RL, Stussman BJ, Herman PM. Out-of-pocket expenditures on complementary health approaches associated with painful health conditions in a nationally representative adult sample. Journal of Pain. 2015;16(11):1147-1162.