We need better treatment for back pain

Issue 59 l Eka’s Weekly Roundup (26 January 2024)

Jan 26, 2024

This week, we owe a big thanks to Finn from Flok Health for having flagged the Lancet series on low back pain. We’re currently conducting our annual impact reporting, and reviewing new data for areas in which we have already invested.

It reminded us just how prevalent musculoskeletal (MSK) conditions are, and why solving this is a huge impact opportunity.

Why the treatment system is broken for back pain 🗞️

Back Pain 101: the number one cause of global disability

There are 500m people worldwide who have activity-limiting low back pain as of 2020. That’s equivalent to 6% of the global population.

Globally, low back pain is now the number one cause of disability. Low back pain was responsible for 60m disability-adjusted life-years (DALY), or a 54% increase since 1990.

Prevalence of LBP in 2020

The financial cost is huge. The direct medical and indirect costs of LBP are more than $50b per year as of 2023.

As a result, low back pain is the most common cause of medically certified sick leave and early retirement in Europe. The EU estimates that the loss of productivity attributable to MSK conditions could be as high as 2% of GDP.

Care pathways don’t match the patient’s best interest

As a result of the high prevalence, care systems have been struggling to cope with volume. Many patients present to the emergency departments, are subject to the liberal use of diagnostic imaging, opioids, spinal injections, and surgery.

A systematic review 14 studies in 2019 found evidence that (counter-intuitively) imaging is associated with (1) higher medical costs, (2) increased health care utilization and (3) more work absence compared with nonimaged groups. In high-income settings, imaging was done for roughly 60% of patients in one study (800 people) who presented with low back pain in an emergency department.

More recently, international clinical guidelines have moved away from medicalized management of low back pain and prioritized non- pharmacological approaches as first line care.

In the UK, First Contact Physiotherapists were brought in to alleviate pressures on the public health system (30% of General Practice visits can be attributable to some MSK condition). But there is still a care gap between the 20m who have MSK-related conditions and the 8m who are currently receiving MSK-related care in the NHS.

The latest NHS data suggests >300k people on the MSK waiting lists as of November 2023.

This means funding existing solutions leads to diminishing marginal impact returns

In the Lancet’s recent review of the original 2018 study, it called for health care funders to stop paying for ineffective & harmful tests and treatments, and redesign pathways.

New models are emerging which ensure 1) better access 2) health equity and 3) faster treatment times.

Flok Health is the UK’s first autonomous personal physiotherapy clinic. They combine Artificial Intelligence and human physios to give patients world-class care with no waiting lists. It is the only technology with MHRA approval to autonomously assess and treat back pain, and the only full pathway digital MSK provider approved by the CQC (England's Health & Social Care regulator).

By specifically focusing on public healthcare systems and intrinsically scalable delivery, Flok are targeting population-scale impact. This is particularly important in MSK, where people from disadvantaged socioeconomic backgrounds are 33% more likely to have an MSK-related condition than those from richer backgrounds

We get really excited about these sorts of models in Consumer Health. If you’re building something around 1) widening access, 2) improving quality of care, 3) shifting towards preventative behaviour models, we’d love to hear from you!