I've heard the indirect costs of back pain are as much if not more than the direct costs. What are these indirect costs?

Direct costs refer to actual money spent on the treatment of back pain at any health care service. This includes hospital visits, surgery, drugs, X-rays and so on. Indirect costs are often calculated based on lost time at work, lost wages, and lost productivity.

If a spouse, partner, or family member has to miss work to care for the patient, the costs to the caregiver can be direct or indirect. This may be lost wages (direct), emotional stress (indirect), physical fatigue, and decreased productivity at home. Even ordering out food for dinner can be counted as a cost if the caregiver can't take the time to prepare a meal while caring for the patient.

Loss of money into a retirement pension while the patient is on sick leave is another indirect costs. Some indirect costs can't be given an equal dollar amount. This relates to quality of life issues such as personal happiness, sexual function, or loss of sleep.