A headline in The Times caught my attention this week: more than 52,000 people in England and Wales are receiving Personal Independence Payment (PIP) with “non-specific back pain” recorded as their main disabling condition.
As an osteopath who has spent nearly four decades assessing and treating people with back pain, I found the story fascinating — but also rather uncomfortable.
There are two very different truths here. The first is that non-specific back pain is absolutely real. Indeed, most back pain falls into this category. The second is that the number of people receiving disability benefits for it has increased remarkably quickly.
According to the figures behind The Times report, the number rose from 32,867 in April 2021 to 52,210 in April 2026 — an increase of 58.9% in just five years.
That cannot simply be dismissed. So how do we distinguish somebody genuinely unable to function because of persistent pain from somebody whose symptoms might reasonably permit them to work?
That, I think, is where this becomes a much more interesting discussion.
Gerry at The Health Equation
In the accompanying podcast, I explore the difficult relationship between back pain, disability, work and our rapidly increasing benefits bill.
Non-specific back pain is not imaginary pain. But equally, a diagnosis of pain should not automatically become a destination of permanent disability.
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Gerry Gajadharsingh writes:
A 59% increase deserves attention
In April 2026, 52,210 people in England and Wales were receiving PIP with non-specific back pain recorded as their principal disabling condition. Five years earlier the corresponding figure was 32,867. That represents a 58.9% increase.
The analysis reported in The Times also identified considerable geographical variation and raised questions about whether conditions that are inherently difficult to verify objectively make the benefits system more vulnerable to exaggerated or inappropriate claims.
Those are legitimate questions, but the figures cannot tell us how many individual claims are genuine, exaggerated or fraudulent.
This is where we need to avoid both extremes. It would be wrong to assume that 52,000 people are malingering. But it would be equally unhelpful to regard a nearly 60% increase in five years as something requiring no explanation.
The bigger picture is even more striking
This is not simply a story about backs. Britain has experienced a substantial increase in ill-health-related economic inactivity. Millions of working-age people are now economically inactive because of long-term sickness, while the overall welfare bill continues to rise.
So perhaps the broader question is:
Why has ill health apparently become so much more disabling to the working-age population?
Yet non-specific back pain really is non-specific
This is where the story becomes a Catch-22.
The great majority of low back pain is classified as non-specific. That doesn’t mean imaginary. It means that we cannot confidently identify a single pathological structure responsible for the patient’s symptoms.
Two people can have almost identical MRI scans and completely different levels of pain and disability. Conversely, somebody can have severe pain with relatively modest imaging findings.
Pain is influenced by anatomy, inflammation, movement, muscle function, nervous-system processing, sleep, psychological state, metabolic health, physical conditioning and many other factors.
This is precisely why judging disability from pain is so difficult. There is no blood test for pain. There is no MRI measurement that tells us how much pain somebody is experiencing. And there is certainly no scan that tells us whether that person could reasonably work six hours a day rather than none.
I have experienced the problem from the other side of the consulting room
Some years ago, I developed a severe lateral lumbar disc protrusion. I temporarily lost the functional use of my right leg and at one stage required eight different medications to control the symptoms.
It was not non-specific back pain. There was demonstrable pathology and significant neurological dysfunction.
But I continued working.
I mention this not because my experience should be used as a yardstick for somebody else’s disability. Different jobs, pathologies, pain responses and personal circumstances make that comparison impossible.
I mention it because it taught me something important: there is a difference between having pain, having pathology and being incapable of all work.
Those three things overlap, but they are not synonymous.
Being self-employed gives you a rather different perspective
For much of my working life I have been self-employed. If I don’t work, I don’t earn.
There is no employer-funded occupational sick pay and no paid annual leave. And while self-employed people can and should make their own pension provision, there is no employer making pension contributions on their behalf.
That last point is sometimes overlooked.
For an employee enrolled in a qualifying workplace pension, the statutory minimum employer contribution is currently 3% of qualifying earnings. But some public-sector arrangements are substantially more valuable. Civil Service employers, for example, currently contribute at a rate of 28.97% of pensionable pay, while the NHS Pension Scheme has an overall employer contribution equivalent of approximately 23.7%, although part of this is centrally funded by government.
These are defined-benefit schemes, so those percentages should not be interpreted in exactly the same way as money being deposited into an individual’s private pension pot. Nevertheless, they illustrate the considerable value of employer-supported pension provision.
A self-employed person has to fund retirement provision from their own income.
That is part of a wider economic difference between employment and self-employment which, in my experience, inevitably affects one’s relationship with work.
If you wake up feeling unwell and not working means not being paid, you face a rather different calculation from someone whose income continues through an employer’s sickness scheme.
There is some evidence that this difference is reflected in behaviour. A Department for Work and Pensions study found that 26% of self-employed people reported sickness absence compared with 32% of employees. More strikingly, only 4% of self-employed respondents reported sickness absence lasting four weeks or more, compared with 9% of employees.
This does not prove that employees are less resilient or that sick pay causes sickness absence. Self-employed and employed populations differ in many ways, and there is another side to the argument: some self-employed people may continue working when medically they really should stop.
But it does demonstrate something important:
The economic environment in which somebody works can influence how illness translates into absence from work.
We are losing an enormous number of working days
In 2025, an estimated 148.8 million working days were lost to sickness or injury in the UK, equivalent to approximately 4.4 days per worker.
That represents an enormous human and economic burden.
Again, however, the interesting question is not whether illness exists. Of course it does.
The question is why one person with a particular condition continues working, another works with modifications, another temporarily stops working and successfully returns, while another progresses into long-term economic inactivity.
Medicine needs to become much better at understanding that transition.
Support and incentives are not mutually exclusive
This is where discussions about welfare frequently become unnecessarily polarised.
One side sees people receiving disability benefits and assumes abuse. The other sees any attempt to tighten eligibility as an attack on genuinely disabled people.
Clinical practice teaches you that reality is considerably messier.
There are people with profound disabilities who unquestionably need long-term financial support. There are people with temporary illness who need support while they recover. There are people who could work if employers provided appropriate adjustments. There are people who have become deconditioned and frightened of movement after prolonged pain. There are people for whom the healthcare system has failed to provide effective rehabilitation.
And inevitably, in any benefits system based partly upon symptoms that cannot be objectively measured, there will also be some people who exaggerate their incapacity or exploit the system.
The challenge is identifying which is which.
PIP itself is easily misunderstood
PIP is not technically an unemployment benefit. It can be paid to people who are working and is intended to contribute towards the additional costs associated with long-term disability or ill health.
Eligibility is based principally upon how a person’s condition affects defined activities of daily living and mobility rather than simply upon their diagnostic label.
That makes sense. But it also creates a considerable assessment challenge when the principal symptom is something inherently subjective such as pain.
We therefore need an assessment system capable of being simultaneously compassionate and rigorous.
Those are not contradictory objectives.
Perhaps work itself needs to become part of treatment
For most uncomplicated musculoskeletal conditions, prolonged withdrawal from normal activity is rarely the therapeutic objective.
We encourage movement, rehabilitation, graded increases in activity and patients regaining confidence in their bodies.
So why should employment always be treated differently?
Sometimes the appropriate prescription might be not “you cannot work”, but “how can we modify your work so that you can?”
Reduced hours, different duties, more frequent movement, temporary restrictions on lifting, working partly from home, a staged return or appropriate rehabilitation running alongside employment may all be possibilities.
The goal should surely be to maintain participation wherever that is medically reasonable, while providing proper support for those genuinely unable to do so.
“Non-specific” must not become “nothing can be done”
When I assess somebody with persistent back pain, I am not simply interested in which lumbar structure might hurt. I want to understand why this particular person has not recovered.
My Integrated Regulatory Systems Framework™ (IRSF) considers seven interacting systems: respiratory; neural; circulatory; endocrine; immune and inflammatory; metabolic; and musculoskeletal.
Not every system is relevant to every patient. But chronic pain often cannot be understood by looking at one anatomical structure in isolation.
Sleep, breathing dysfunction, stress, metabolic health, deconditioning, inflammation, fear of movement and altered pain processing may all contribute.
Calling somebody’s problem “non-specific back pain” should therefore be the beginning of reasoning, not the end of it.
The uncomfortable middle ground
I suspect the truth lies in an uncomfortable middle ground.
Britain undoubtedly has many people living with genuine chronic pain and disability who deserve both our compassion and financial support. We also have a healthcare system that is frequently poor at rehabilitating persistent musculoskeletal pain.
But at the same time, a 58.9% increase in PIP claims for non-specific back pain in five years deserves serious scrutiny.
And the wider rise in long-term sickness and economic inactivity deserves scrutiny too.
The objective should not be to prove that people are ill. Nor should it be to prove that they are not.
It should be to determine, as accurately and fairly as possible:
What can this person reasonably do? What treatment or rehabilitation might improve that capacity? What workplace adaptations would help? What support do they genuinely require?
And perhaps most importantly:
How do we prevent temporary illness from becoming permanent disability when recovery and participation remain possible?
That is a much more difficult question than simply counting benefit claimants.
But it is also a much more important one.
Sources
The Times, 25 September 2026. More than 52,000 claiming benefits for non-specific back pain.
TaxPayers’ Alliance. Analysis of non-specific back pain PIP claims.
Office for National Statistics. Sickness absence in the UK labour market: 2025.
Department for Work and Pensions. Employee and self-employed research on sickness absence.
GOV.UK. Workplace pensions: what you, your employer and the government pay.
Civil Service Pension Scheme. Employer contribution rates.
NHS Business Services Authority. NHS Pension Scheme employer contribution rates.
World Health Organization. Low back pain.