Managing the Many Costs of Low Back Pain
By Kate Leiser, PT, DPT, OCS
Low back pain is one of the most common conditions that we treat here in our Upper Valley clinic. In fact, it is such a common complaint that it is documented as the leading cause of activity limitation and work absence in the world.8 Many of our patients come to see us after they’ve seen their primary care physician, and/or a specialist, undergone imaging, received advice from friends and family, and (more often than not) have done a pretty thorough Google search to learn more about their condition. With all the information out there, patients often become scared, frustrated, and confused about their pain. Here are some useful, current facts on low back pain:
- The prevalence of chronic, debilitating low back pain is rising; despite an estimated 85 billion dollars in related medical expenditures in the U.S. in 2005.5
- Degenerative changes on imaging studies (radiographs, MRI, CAT) are not strongly associated with symptoms. High false positive rates on imaging studies (picking up structural changes unrelated to the symptom(s)) make it difficult to link structural pathology to pain.3, 4
- Any innervated structure in the spine can cause low back symptoms and even referred pain into the legs.3, 9
- Even though the pain may be severe, MOST low back pain is not caused by a serious problem.
- Early physical therapy treatment following the onset of pain symptoms has been shown to reduce overall medical expenditure associated with an episode of low back pain.5
- A patient’s own expectations for recovery play a large role in whether or not they get better.
What does this all mean for cutting the time and financial costs in the treatment of low back pain? The current best evidence for treatment of low back pain de-emphasizes identifying the anatomic structures that MAY be causing symptoms and focuses instead on grouping patients into categories of treatment for which they are MOST LIKELY to benefit based on symptoms and clinical examination.6, 7 This helps to make treatment more efficient, saving both time and money. In fact, in a study examining the total healthcare costs over the course of an acute case of low back pain, patients receiving care adherent to these guidelines saved an average of $1374.39 compared to those receiving non-adherent care.5 The recommended groupings of treatment are:
- Manipulation via thrust/non-thrust manipulation
- Control/stabilization exercises for the trunk musculature
- Specific directional movements/exercise (often described as the McKenzie Approach to treatment)
- A very small group of patients may benefit from mechanical traction, although there is less support for this as an intervention tool.3
As with any medical or physical therapy treatment, not everyone is or should be treated exactly the same way. This is due to individual differences in initial presentation of symptoms as well as the way those symptoms and clinical signs change over time. As a result, it is very common for patients to move from one category to another as they move through their episode of care.
If you are experiencing an episode of low back pain, it is important remain active, avoid bed rest, try to control stress levels, and get a good night’s sleep.2 If you are having difficulty managing on your own, it is recommended that you seek advisement from your physical therapist on ways to modify behaviors or activities to reduce and manage symptoms. It has been shown that physical therapy treatment received early within an acute episode of low back pain can help to decrease the likelihood of additional physician visits, major surgery, lumbar spine injections and opiod medications.5 If you need assistance managing your low back pain, give us a call before the time and financial costs begin to add up.
- Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147(7): 478-491.
- Dahm KT, Brurberg KG, Jamtvedt G, Kagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Systematic Reviews. 2010; http://dx.doi.org/10.1002/14651858.CD007612.pub2
- Delitto A, George SZ, Van Dillen L, et al. Low Back Pain Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2012; 42(4): A1-A57.
- Elliot J, Flynn T, Al-Najjar A, et al. The Pearls and Pitfalls of Magnetic Resonance Imaging for the Spine. J Orthop Sports Phys Ther. 2011; 41(11): 848-860.
- Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary Care Referral of Patients with Low Back Pain to Physical Therapy. Spine. 2012; 37(25): 2114-2121.
- Fritz JM, Cleland JA, Childrs KD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007; 3(6): 290-302.
- Fritz JM, Delitto A, Erhard RF. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine. 2003; 28: 1263-71.
- Keat PM, Keating JL. The epidemiology of low back pain in primary care. Chiropr Osteopat. 205; 13: 13.
- Kuslich SD, UlstromCL, Michael CJ. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am. 1991; 22: 181-187.