"How's your back?"

Nancy Pelosi is the new Speaker of the House but she has some illustrious (as well as not so illustrious) predecessors. Denny Hastert was not so illustrious. Tip O'Neill, the legendary congressman from Massachusetts, was another matter. O'Neill rented an apartment in Washington, DC, but mostly continued to live amongst his constituents in North Cambridge. One of his specialities was "constituent services," which meant anything from solving minor problems with the bureaucracy to finding jobs or government contracts. He is the source of the adage, "All politics is local" and he practiced retail politics as few others have.

There were tens of thousands of people in O'Neill's district but he knew many of them on a first name basis. Of course he couldn't really remember all of their names. But he had a simple strategem to make them think he did. He'd see them at a campaign event or community gathering where he made an appearance, and if they were thirty or more he'd put his around around them, give them a big smile and say, "How's your back?" The fact he remembered they had a back problem never failed to impress.

Now a new report from CDC explains how this works. Using data from the last several years worth of a national health survey of the US population, the CDC reports that about one in four Americans have had episodes of low back pain in the last three months (via MedicineNet). Low back pain leads the list of body parts that hurt, but there are many others. Migraines or severe headaches and joint pains (the knee being most common) also top the list. 25% of the survey sample had an episode of pain that lasted longer than 24 hours in the previous month and 10% had pain lasting more than a year.

The prevalence of low back pain, O'Neill's secret weapon, is important in other ways, too:

The authors noted that chronic low back pain was associated with lower health status among a substantial number of adults surveyed.

"In 2004, adults who reported low back pain lasting more than 24 hours during the past three months reported worse health status, using a number of different measures, than people who did not report recent low back pain, regardless of age," they wrote.

"Overall, 28% of adults with low back pain said they had a limitation of activity caused by a chronic condition, compared with 10% of adults who did not report low back pain. Adults with recent low back pain were about three times as likely to report fair or poor health status and more than four times as likely to experience serious psychological distress as people without low back pain." (Medpage Today)

Treating low back pain can be frustrating and cumulatively expensive. It's not that there are no treatments for low back pain. There are a huge number of them, meaning none of them work particularly well. I am quite familiar with quite a few, myself. The amount of money spent on over the counter remedies, from analgesics to heating pads or thermocare or lidocaine patches to chiropractic, acupuncture or surgical treatments is staggering. It could probably feed your average sub-Saharan nation for a year.

Even the second ranking source of pain, headaches, is big business:

"In 2002-2003, ambulatory medical care or prescribed medicine expenses for headaches averaged $566 per person for headache-related care among non-institutionalized adults who reported a headache expense," the CDC researchers wrote, "representing more than $4 billion in total expenses -- not including self-treatment, over-the-counter drugs, and inpatient hospital expenses for this condition."

That's $4 billion without counting over-the-counter remedies. That means with the new Medicare prescription drug plan, paying for headaches has become a gigantic positive feedback loop.