Spine Pain Care

Fellowship Year 2014-2015

In 2005, the national expenditure for back and neck pain (spine pain) approached $86 billion; meanwhile, patients with spine pain reported worse physical and social function, mental health, and ability to work than a decade prior, when spending was nearly 40% lower. Over the same time period, the prevalence of disability attributed to musculoskeletal pain — of which back pain contributed a large portion — rose from 20 to 25%, alongside an alarming 16,000 annual deaths related to overdose of prescription opioid medications.  In brief, over the last few decades, we are spending more and getting much less. Because the status quo follows an unsustainable trajectory, we sought to identify a higher-value method of care delivery that lowers national health care spending and improves outcomes for patients with spine pain.

Safely reducing per capita spine pain spending

CERC’s team focusing on redesigning care for spine pain identified three main addressable points of failure in the current care of spine pain, summarized in the table below. Utilizing a modified version of the validated STarT Back risk assessment tool, the novel ICE Model for Spine Pain Care addresses these failure points via three core elements: (1) the immediate triage of patients at low risk of chronic spine pain into conservative care to prevent overtreatment of self-limited pain; (2) the administration of customized care for patients at high risk of chronic spine pain into a high-touch care pathway that address both physical and psychosocial risk factors; and (3) the enhancement of decisions for patients and providers via shared decision making tools for preference-sensitive procedures and decision support aids during physician order entry.

Estimated savings

Conservative forecasts show the ICE Model could result in a net reduction in per capita spending for spine pain by 25%, or $21.5B in direct care costs. Taking into account lost productivity, savings could grow to over $70B annually.


Sierra Matula, MD, MSHS, Lawrence Huan, MD, Arthur Wood, MD, Terry Platchek, MD, Donna Zulman, MD, MS, Arnold Milstein MD, MPH 2015