Study: Immediate physical therapy for low back pain may reduce health-care costs, opioid use

Patients with acute low back pain who get a referral for physical therapy and are treated within three days use fewer opioids and have lower health-care costs, according to a study led by a UCF researcher.

The study also showed that early physical therapy lowered the need for healthcare services such as advanced imaging, spinal injection, ER visits and spine surgery.

Researchers said this is the first population-based study to show the benefits of immediate physical therapy for patients who have acute low back pain, which is the most common cause of work-related disability. It’s estimated that costs associated with low back pain are more than $100 billion each year.

“Low back pain is the cause of significant pain, disability and loss of productivity,” said Xinliang Liu, an assistant professor in the Department of Health Management and Informatics at UCF and the study’s lead author, in a news release. “Decisions about treatment have important implications for the health care industry.”

The study adds to the body of research that shows earlier intervention with physical therapy benefits most patients with low back pain, but it also further fuels controversies around the issue.

After reviewing the study, what stood out to Dr. Philip Meinhardt, an orthopedic spine surgeon at Jewett Orthopaedic Clinic in Orlando, was numbers that showed patients who didn’t receive any physical therapy at all had the lowest health-care use and related costs, even compared with those who got physical therapy within three days.

“What the study really does, is echo what we've known for a long time: acute lower back pain is extremely common,” said Meinhardt. “Even though when these episodes are very severe, they’re usually self-limiting problems and usually resolve within six weeks.”

About 80 percent of adults experience back pain at some point during their lifetime, according to the National Institutes of Health.

Low back pain typically involves the five vertebrae in the lumbar region, which support most of the weight of the upper body. Several factors lead to back pain, although the majority are because of mechanical problems that occur in joints, discs and bones of the spine, according to the NIH.

“For anatomic reasons, the back is more susceptible to injuries and patients are concerned, because the pain is more severe than what they've experienced their life,” Meinhardt said.

Using a large commercial health insurance claims database in New York State, which captured about 10 percent of the state’s total population under age 65, Lui and colleagues analyzed the data for 47,000 patients who were newly diagnosed with low back pain. About 6,700 of them had received physical therapy.

Analyses showed that among the newly diagnosed patients and got physical therapy, those who had the therapy within three days of diagnosis had the lowest need for imaging, opioid medications, specialist visits and surgery. Those who received physical therapy after 15 days, had increased use and cost of health care.

Lui said during a presentation at UCF that if he had a magic wand, all patients who needed physical therapy would start within three days of diagnosis. That alone could lead to more than $7 billion in cost savings in the U.S. Meinhardt wasn’t so sure. He said he typically give his patients anti-inflammatory drugs, tells them to remain mobile, and advises against bed-rest. If after a few weeks these interventions don’t work, then he turns to physical therapy.

“I don’t have anything against physical therapists.We have many physical therapists here in Jewett,” Meinhardt said. “The biggest thing is not the getting them in [to see a physical therapist]. It’ not to over treat low back pain.”