Home / Hot Topics / New statistics reveal that the growth of benefit claims for back pain in the UK is now starting to reverse - so was back pain a twentieth century epidemic?

Hot Topics latest - October/November 2002

New statistics reveal that the growth of benefit claims for back pain in the UK is now starting to reverse - so was back pain a twentieth century epidemic?

Back pain, incapacity for work and social security benefits: an international literature review and analysis

Authors: Professor Gordon Waddell; Professor Mansel Aylward and Dr Philip Sawney

Published: October 2002 - The Royal Society of Medicine Press Ltd.
Reception to launch: Monday 4 November 2002 at 6.30 at the Royal Society of Medicine

The latest UK statistics show that the rising trend of social security benefits for back pain has begun to reverse with a 42% decrease in annual new awards for back pain since the mid 1990s. Whilst there has been a decrease in new benefit awards for almost all conditions the change for back pain is most marked and probably represents changes in medical practice and cultural attitudes towards back pain. These and other key statistics are presented and analysed in a major new scientific review.

Using back pain as an example, the authors reviewed the literature and data on social security arrangements in different EU and OECD countries and integrated the findings with a modern biopsychosocial model of pain and disability. The findings provide a factual and theoretical background to the ongoing social security debate on disability benefits.

Key points:

• Recent trends in the UK are encouraging, though back pain remains a leading cause of sickness absenteeism in the workplace, of long term disability and of benefit dependency.
  
  
• This review shows that back pain is not a discrete health problem but is often associated with other pains, co-morbidities, psychological and social problems.
  
  
• Trends of incapacity for work, and related benefit payments, attributed to back pain form a social phenomenon that depends on a combination of health care, cultural attitudes to back pain,and socio-economic factors.
  
  
• These trends suggest that much chronic disability from back pain should be preventable.

Speaking at the launch of the book Professor Mansel Aylward, Chief Medical Adviser to the Department for Work and Pensions, said:

" The epidemic proportions of back pain disability we saw in the latter half of the 20th century may be starting to subside but even so back pain remains a considerable problem for the UK and other developed nations.

The success has been mainly in reducing the numbers who become long-term disabled but more effective early interventions to limit the persistence of low back pain are still required.

The challenge we must also confront is to find a better healthcare or rehabilitation answer for people with chronic back pain who are already long-term incapacitated. Social security arrangements have an important part to play in ensuring a better functional outcome for patients. "

Professor Gordon Waddell added:

"There has been a radical change in medical understanding and management of low back pain and disability during the last decade. However, the findings from this review clearly demonstrate that, from a social security perspective, back pain is not simply a health problem but often raises more fundamental psychosocial issues.

This has important implications for the management of disability, for rehabilitation and for society in general. Also, many of the key issues raised may be equally relevant to other common social security problems such as musculoskeletal complaints, stress related disorders and chronic fatigue. "

Background notes

1. Back pain is one of the most common reasons for chronic disability and incapacity for work in the western world. In the UK up to 50 million working days are lost each year and up to half a million people receive a long term state incapacity benefit because of back pain. In addition to the impact on individuals and their families back pain is estimated to cost the UK economy up to £ 5 bn a year

2. The latest UK statistics provided by the Department for Work and Pensions show that the rising trend of social security benefits for back pain has been reversed since 1994-95, with a 42% decrease in new awards for back pain, compared with a 25% decrease for all conditions.

Just over half the fall is in common with all conditions and is probably due to changes in the social security system. Rather less than half is unique to back pain, and is probably due to changed medical thinking and cultural attitudes about back pain. The main improvement has been in the number of people developing chronic back pain and incapacity, who claim and start benefits.

3. Modern evidence based medical management of low back pain emphasises the need to keep active and get on with life rather than waiting until the pain disappears completely. Where chronic low back disability does develop, psychosocial factors appear to be just as important as the physical pathology.

4. There have been very few attempts to relate the scientific and social security literature and data on back pain and none as extensive in scope as the present review.

5. About the authors:

Professor Gordon Waddell - is a medical scientist from Glasgow and an internationally recognised authority on back pain and the biopsychosocial model of disability.

Professor Mansel Aylward - is Chief Medical Adviser to the Department for Work and Pensions and Honorary Professor of Psychosocial and Disability Medicine at Cardiff University and the Welsh National College of Medicine. He has published widely on disability and incapacity issues.

Dr Philip Sawney - is Principal Medical Adviser to the Department for Work and Pensions. He has published papers on Disability Assessment Medicine and Sickness certification.

6. The book is published by the Royal Society of Medicine Press Ltd. ISBN: 1-85315-542-X

Acknowledgement - The publication of this review was financially supported by an educational grant from the Department for Work and Pensions (DWP) but the views and opinions expressed are those of the authors and do not necessarily reflect the views of the DWP.

All information on this site was correct at publication and is subject to © Crown Copyright