By Pat Anson, Editor

Early physical therapy for low back pain significantly lowers healthcare costs by reducing the use of expensive treatments such as spinal surgery, injections, imaging and painkillers, according to a large new study published in the journal BMC Health Services Research.

About a quarter of Americans report an incidence of low back pain (LBP) within the previous three months and it is one of the most common reasons to visit a physician. Most LBP episodes resolve within 2 to 4 weeks, but about 25% of patients will experience recurring back pain for a year or more. 

Researchers analyzed health care records for over 122,000 patients in the U.S. Military Health System who went to a primary care physician for an initial episode of low back pain and received physical therapy within 90 days. 

Over 17,000 patients in the study received early physical therapy within 14 days – and it was this group that made significantly less use of advanced imaging, spinal injections, spine surgery and opioids than patients who started physical therapy later. 

Health care costs on average were 60% lower (about $1,200) over a two year period for patients who had early physical therapy compared to those who delayed therapy.

"Physical therapy as the starting point of care in your low back pain episode can have significant positive implications," said physical therapy researcher John Childs, PhD. "Receiving physical therapy treatment that adheres to practice guidelines even furthers than benefit."

Medical guidelines recommended for low back pain are to avoid opioids and advanced imaging as a first-line of treatment. However, recent research shows those guidelines are often ignored.

A large new study by pharmacy benefit manager Prime Therapeutics found that about one in five opioid prescriptions were written to treat low back pain.

"Low back pain was the most common diagnosis among all members taking an opioid, even though medical guidelines suggest the risks are likely greater than the benefits for these individuals," said Catherine Starner, PharmD, lead health researcher for Prime Therapeutics.

Another study of older adults with low back pain found that spending thousands of dollars on advanced imaging such as CT scans or MRI’s within six weeks of visiting a primary care doctor was often a waste of money.  

“Early imaging was not associated with better one-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain,” said Jeffrey G. Jarvik, MD, a professor of radiology in the University of Washington School of Public Health, who studies the cost effectiveness of treatments for patients with low back pain.

Combined direct and indirect costs for low back pain in the U.S. are estimated to be between $85 billion and $238 billion a year.

"Given the enormous burden of excessive and unnecessary treatment for patients with low back pain, cost savings from physical therapy at the beginning of care has important implications for single-payer health care systems," said Paul Rockar, President of the American Physical Therapy Association.