Drug-free approaches to back pain may deliver better value

Several non-drug treatments for low back pain may improve patient outcomes while costing less than standard care, according to a review of economic studies.

Among the approaches that showed promising results were yoga, psychological support, and programs that help people manage pain in everyday life.

Low back pain remains a leading cause of disability. For health systems deciding which services to support, it is important to know not only whether a treatment works, but also what it costs to deliver.

Researchers examined 20 studies involving 14,884 people. The review, published in PLOS Medicine, looked at treatments that avoided drugs and surgery and compared them with usual care or no treatment, depending on the study design.

Five approaches appeared to lower costs while improving outcomes compared with usual care: yoga, cognitive behavioral therapy, self-management support, education designed to reduce fear, and mindfulness-based stress reduction.

Cognitive behavioral therapy helps people explore how thoughts and habits shape their response to pain. Education aimed at reducing fear can help explain why some people avoid movement even when activity is still possible. These methods focus on how pain affects daily functioning.

Two combined programs also showed favorable value: workplace advice paired with gradually increasing activity, and diet support combined with physical activity. The review measured them against a UK benchmark for what a health system might reasonably pay for a gain in health.

Better value does not always mean lower spending. A program may cost more than usual care and still be considered cost-effective if the health gains are large enough to justify the added expense.

All of the studies were conducted in high-income countries, and the researchers used different methods to measure costs and outcomes. A program that saves money in one setting may cost more in another, depending on staffing, prices, and the type of usual care already available.

The review does not identify a single best treatment for everyone with back pain. Instead, it suggests health systems should take a closer look at offering several options and test whether the benefits and costs remain in real-world settings.

If you are interested in this topic, please read articles about Aquatic Therapy Eases Back Pain and Improves Mental Health, and Acupuncture May Safely Ease Chronic Back Pain in Older People.

For more information, please see articles about Mindfulness and Cbt Help Reduce Chronic Back Pain and Opioid Use, and Focusing on Hips May Be the Key to Treating Chronic Back Pain.