Study: PT best for low back pain

With so many Americans suffering from aching backs, physical therapy could be their best option

Back pain is the bane of the existences of many Americans. As people get older, stress—both physical and environmental—takes its toll, resulting in aches and pains that develop and often worsen over time. For many people, this pain is focused in the lower back region.

The crisis is multilayered, with one report claiming Americans are spending close to $100 billion annually on relieving their back pain. But throwing money at the problem has done little to alleviate the symptoms, as evidence continues to accumulate that standard treatments—including injections and even surgery—are doing little to solve the problem.

Add in the ongoing opioid crisis, and it’s easy to see why Americans are desperate for a solution. Enter the field of physical therapy.

A study published last week in the journal Health Services Research indicates that when lower back problems crop up, physical therapy should be the patient’s first stop, rather than a last resort. The potential benefits are time and money saved, plus a lower likelihood of having to progress to pain medications (including opioids).

A group of researchers from George Washington University in Washington, D.C. plus a group from the University of Washington in Seattle, WA, examined over 150,000 insurance claims filed across six states. They cross-referenced these claims with 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.

“Compared to patients who saw a PT later or never, patients who saw a PT first had lower probability of having an opioid prescription, any advanced imaging services, and an Emergency Department visit,” wrote the researchers. “These patients also had significantly lower out‐of‐pocket costs, and costs appeared to shift away from outpatient and pharmacy toward provider settings.”

Specifically, there was a remarkable 89 percent lower chance of requiring an opioid prescription for patients who started in physical therapy.

Advanced imaging services were required 28 percent less frequently, while emergency room visits were reduced by 15 percent. Patients who started in PT did have a higher chance of hospitalization (19.3 percent) than their peers (all numbers p < .001).

In terms of costs—the initial impetus for the study—well, those were reduced as well.

“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.

Ms. Frogner added that while many patients could benefit from seeing a physical therapist before pursuing other means of treatment, they fail or refuse to do so because of insurance restrictions, a lack of insurance, or trepidation over the amount of copayments.

“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.”

The one statistic that stood out as a potential negative for physical therapy was the 19 percent higher rate of hospitalizations among patients who tried PT first (a separate statistic from the one that showed 15 percent fewer ER visits.) While the research teams didn’t have the cause of each hospitalization at their disposal, Frogner was willing to speculate, saying that in many cases, the prevalence of comorbidities such as obesity or diabetes may have been the culprits.

“It could also be that the physical therapist was able to identify more serious problems on the first visit, and refer patients on to more specialized care,” she added.

But in an era where reducing healthcare costs –and keeping patients away from opioids at any cost—are primary considerations, trying physical therapy fist may hold the key to solving both problems for countless patients.

“We need to look for better ways to help patients manage the current pain they have and prevent it from coming back in the future,” concluded Frogner. “Physical therapists are well positioned to provide ideas on exercises, movement and ways of living to prevent the pain from getting worse—and hopefully from ever coming back, once it’s gone.”