Physicians have been trying to find a quick, effective way to treat back pain. This has included oral medications, shots, and even surgery. While some of these have provided short term relief, most have not been effective for long term relief.
Though Americans spend an estimated $80 billion to $100 billion each year in hopes of easing their aching backs, the evidence is mounting that many pricey standard treatments — including surgery and spinal injections — are often ineffective and can even worsen and prolong the problem.
A study published Wednesday in the journal Health Services Research suggests trying physical therapy first may at least ease the strain on the patient’s wallet in the long term — and also curb reliance on opioid painkillers, which carry their own risks.
The researchers, from the University of Washington in Seattle and George Washington University in Washington, D.C., analyzed more than 150,000 commercial health insurance claims filed between 2009 and 2013 in six northwestern states. They checked the files of patients who had a new diagnosis of low back pain, comparing the insurance claims of people who had received physical therapy before seeing their family doctor or a specialist to those of people who received PT at a later date, or not at all.
The study wasn’t designed to look directly at how well physical therapy ameliorates pain. Instead, the researchers wanted to see if physical therapy reduced overall health care costs and patient outlay related to back pain — including the number of opioid prescriptions and the number of advanced imaging tests like MRIs and CT scans, as well as hospitalizations and ER visits.
It turned out that patients who saw a physical therapist before trying other treatments had an 89 percent lower probability of eventually needing an opioid prescription, a 28 percent lower probability of having any advanced imaging services, and a 15 percent lower probability of making one or more ER visits.
Overall, patients saw “significantly lower out-of-pocket costs — on the average, $500 — when they visited a physical therapist first,” says Bianca Frogner, a health economist at the University of Washington, and lead author on the study.
“People who get trained in physical therapy have very specialized knowledge about pain management,” she says, “especially with the muscular skeletal system. They might actually understand this pain better than the average family physician.”
It’s also worth noting, she says, that some patients who could benefit from physical therapy don’t get it, because of health insurance restrictions, or because they lack insurance, or the copayments are too high.
Kenneth Harwood, a coauthor of the study and a physical therapist who directs the program in health care quality at George Washington University, says PT can diminish a patient’s pain and improve movement.
The therapists can guide patients through exercise regimens that strengthen muscles and help them develop control over their movements, including improving posture, he says.