The Most Effective and Lowest Cost Option to Treat Low Back Pain
By MarieNelson on October 6th, 2020
Lowest Cost Treatment for Back Pain
Chances are, you or someone you know has had back pain. Over the course of our lives, 80% of us will have an episode of back pain. Even though back pain is common, the medical community does a poor job managing it. Stories of chronic pain, opioid use, multiple surgeries, and a lifetime of disability are far too common.
The Alliance for Physical Therapy Quality and Innovation (APTQI) recently assessed different treatment interventions for low back pain within the Medicare program. The study looked at total costs for treating back pain in 472,000 Medicare beneficiaries. The study revealed the average total cost of care for low back pain was lowest for those who received physical therapy first. Costs including doctor visits, testing, treatment, etc. over 120 days averaged out to $3,992 for those who received physical therapy as the first treatment compared to $4,905 for those receiving injections, and $16,195 for those receiving surgery.
Studies also show, the sooner you seek treatment, the lower your costs will be. Patients who were referred to physical therapy within 14 days of low back pain spent $3,500 less than those who received physical therapy within 45-90 days. Let’s take this thought process a step farther. Multiply the $3,500 saved through physical therapy for each patient in the study ($3,500 x 472,000) and you get a savings of $1.652 billion dollars. That’s a whole lot of money that could be saved across the Medicare system just by trying physical therapy first.
Aside from costs, let’s look at hard data of how physical therapy can help treat back pain in patients of all ages. People with back pain are often referred for physical therapy and countless studies and randomized trials confirm that physical therapy has real benefits for back pain sufferers.
In a study released October 6th, 2020, Researchers studied 220 adults, ages 18-60, with back pain and sciatica pain radiating down the leg. The researches assigned half of the back pain sufferers to just one session of education about back care and the other half were assigned to four weeks of physical therapy, including a specified exercise program and manual hands-on therapy.
At four weeks, six months and one year, the physical therapy group showed less disability and decreased back pain intensity compared with the controls. “We know that with back pain and sciatica, being active and exercising within your limits is a good thing to do,” said the lead author, Julie M. Fritz, a professor of physical therapy at the University of Utah. “But there’s an additive benefit in the care provided by a physical therapist. With added physical therapy, you’re less likely to have a prolonged case of disability.”
While physical therapy is a proven treatment option for back pain, let’s look at some of the common treatment options for low back pain to see how they stack up.
Medication – Low back pain is the #1 reason for opioid prescription in the United States. However since 2016, the CDC recommends against the use of opioids for back pain in favor of “non-drug treatments like physical therapy.”
Imaging – Having an X-ray or MRI for back pain is common, however it’s rarely needed or helpful and adds to increased health care costs. Research has never demonstrated a link between imaging and symptoms. As we age, degenerative changes on imaging is common and is a normal part of the aging process. For example, studies show that 90% of people aged 50 to 55 have disc degeneration when imaged, whether they have back pain symptoms or not.
Surgery – The United States has sky high rates for back surgeries at 40% higher than any other country in the world and 5 times higher than in the United Kingdom. You’d think that with all the back surgeries we do, we’d be pretty good at it but the surgical outcomes are terrible. A worker’s compensation study looked at 725 people who had spinal fusions VS 725 people who didn’t. The surgical group had a 1 in 4 chance of a repeat surgery, a 1 in 3 chance of a major complication and 1 in 3 chance of never returning to work again. Ouch! A large review study estimates that 10% to 20% of surgeries are unnecessary and that in some specialties such as cardiology and orthopedics, that number might be higher.
Physical Therapy – Current clinical practice guidelines support manual therapy and exercise. Through manual hands on care and a specified exercise program, many back pain sufferers have resolved their back pain through physical therapy. Research proves that early physical therapy leads to better outcomes with lower costs, and decreases the risk of surgery, unnecessary imaging, and use of opioids.
Despite the data showing that physical therapy is the most effective, safest, and lowest cost option to treat low back pain, most people take far too long to get there. To receive care as quickly as possible, Western Berks Physical Therapy and many other physical therapy providers participate in Direct Access. Direct Access is a state endorsed practice that allows patients to directly seek the services of a physical therapist, without receiving a referral from their doctor.
From rotator cuff tears, degenerative disc disease and low back pain, to meniscal tears, knee pain and osteoarthritis, studies have shown that physical therapy is as effective as surgery in treating a wide range of conditions. Don’t take our word for it though. These universities and doctors already did the homework for us.
- The New England Journal of Medicine found physical therapy to be as effective as surgery for treating meniscal tears and knee osteoarthritis.
- Thomas Jefferson University Hospital found that patients with degenerative disk disease responded as well to physical therapy as to surgery.
- The Bone and Joint Journal found that physical therapy for rotator cuff tears produces results equal to those produced by arthroscopic surgery and open surgical repair.
So if physical therapy is as effective as surgery, why are so many surgeries still occurring? The most common reason for so many unneeded surgeries is that more conservative options aren’t tried first and perhaps, a lack of knowledge by the operating physician.
Physicians undergo long and rigorous training programs to become surgeons, but if they don’t work hard to keep learning, their knowledge often stops growing when they leave residency. Recent research is showing that certain common surgeries aren’t any better than a placebo. Two such examples are kyphoplasty (a procedure for spinal compression fractures), and partial meniscectomy (a procedure used to treat tears of the meniscus in the knee). If a surgeon hasn’t continued to learn, they won’t know that these surgeries often don’t offer any more benefit than a non-surgical treatment and will continue to perform them.
Every surgery, even “minor” ones, carry risks. These include complications from anesthesia, blood clots after surgery, delayed healing of the incision, infection, and unintended damage to nerves or other organs near the surgical site. Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death. For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when surgery can be avoided, it should be.
For musculoskeletal problems like back and joint pain, sprains, and strains, seeing your physical therapist before a surgeon can help keep you out of the operating room and get you back to life without surgery.
Physical therapy for low back pain is available at our conveniently located facilities across Berks County, Pennsylvania in Robesonia, Wyomissing and Laureldale. Call us today at 610-589-2263 or request an appointment here!