Treatment of Low Back Pain — Exploring the Costs

posted at January 4, 2012

Next to the common cold, low back pain (LBP) is the most common reason individuals visit a physician’s office, resulting in billions of dollars in medical expenditures and lost labor costs each year. Low back pain is one of the most common reasons patients visit the emergency room in the U.S. In 2008, U.S. hospitals had roughly 3.4 million emergency department visits — an average of 9,400 a day — specifically for back problems.

Are we treating Back pain effectively?

Currently, the US ranks 46th among industrialized nations in health care outcomes yet it ranks number 1 in costs per capita.

Medicare data illustrates that from 1996 to 2004 (risk adjusted), there was:

  • 629% increase in expenditures for epidural steroid injections
  • 423% increase in opioids prescribed
  • 307% increase in spinal fusions
  • It is also noted that there is a direct correlation between MRI/CT rates and surgeries.

All of this increase in invasive treatment of musculoskeletal problems may be justified if patients’ quality of life and independence was preserved, however that isn’t the case.  In fact, the evidence paints a much different picture.  Social Security disability statistics suggest that disability from musculoskeletal disorders is rising not falling—from 20.6% to 25.4% in 2005.

About 80% of health care and social costs related to low back pain are attributed to the 10% of patients with chronic pain and disability.  This implies that meaningful interventions to reduce the recurrence of low back pain would allow significant cost savings in the current health care system.

Physical Therapy has been shown to be an effective cost saver and has been shown to have good outcomes:

  • In a 2007 Annals of Internal Medicine systematic review of non-pharmacologic therapy, the authors demonstrate the benefit of Manual Physical Therapy and exercise in both sub-acute and chronic low back pain as well as moderate evidence for the use of spinal manipulation in acute low back pain.
  • A review article published in the February 2009 Journal of the American Academy of Orthopaedic Surgeons recommended that in most cases of symptomatic lumbar degenerative disc disease, a common cause of low back pain (LBP), the most effective treatment is Physical Therapy combined with anti-inflammatory medications.

Recent economic studies have demonstrated that physical therapy can be an effective treatment choice for patients while saving them significant money.

The Virginia Mason Hospital system in Washington State was under significant pressure from local employers and health insurance companies to reduce the costs of its services. One of the hospital solutions was to use physical therapy for low back pain treatment prior to specialty care. The outcome of this procedural change has just been published in Health Affairs (Sept. 2011). The results were significant.

  • Costs were reduced per episode by 55%.
  • There was an overall reduction in utilization – less medications, less physical therapy visits, and reduced number of physician visits.
  • Patient satisfaction improved, indicating better outcomes from treatment.

Health Services Research (Oct 2011) has just published a study that compared physician referral to physical therapy, with patient self-referral to physical therapy, (direct access).

  • The total number of physical therapy visits were reduced by 14% when patients accessed physical therapy directly.
  • The physician referred group received significantly more concurrent care – more medications, more imaging, more interventions.
  • There was a staggering 87% reduction in episodic costs when the patient came directly to physical therapy.

Physical therapy ranks among the top treatment choices of Consumer Reports readers with back pain, according to a 2009 survey of more than 14,000 Americans with back pain. Physical therapist treatment and other “hands-on” therapies outranked treatment by medical specialists and primary care providers, a result that should prompt more patients to seek conservative options as a first line of treatment for their back pain.

At a time when people are responsible for paying a greater percentage of their health care services it makes sense to re-evaluate how we treat back pain to assure we maximize value. A conservative trial of 2-3 weeks of physical therapy may be your best and cheapest road to recovery. You can now come to physical therapy without having seen a physician first. You should find a physical therapy company where you see the licensed physical therapist at every visit, not just at the evaluation.

At Results Physiotherapy you are treated at every visit by the same licensed physical therapist. Our therapists will do a comprehensive “hands-on” examination that will pin-point the cause of your pain. The findings will form the basis of the treatment, which includes manual therapy techniques for improving joint mobility and flexibility, along with exercise prescription to impact the identified movement dysfunctions contributing to the pain.

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