Curbing the Outsized Impact of Lower Back Pain: Which Early Intervention is Best?

Looking at early interventions for back pain through physical therapy in Post Falls, ID


Lower back pain (LBP) is one of the most prevalent medical issues in the world. When surveyed, as many as 25 percent of Americans report at least one incidence of back pain within the last three months. Cross-sectional studies from several developed nations indicate that prevalence rates may reach as high as 80 percent over most workers’ lifetimes. Primary care physicians are often the first line of contact in patients seeking treatment, with one 2008 study reporting that a total of 1 in 17 of all primary care visits involve LBP.

Meanwhile, as health care costs reach unprecedented levels, LBP continues to impose an outsized socioeconomic burden on both

the U.S. health care system and those afflicted with persistent pain. Average cost per individual ranges from $1,500–$2,000, with total costs amounting to over $86 billion back in 2005.

It’s clear that reducing the cost of treatment while maintaining effective functional outcomes should be a priority of any medical professional that regularly deals with patients suffering from chronic LBP. But in the midst of the opioid epidemic, the medical field’s perceived overutilization of imaging services and the mixed efficacy of surgical intervention, there is some question of how best to accomplish this task.

One Potential Target for Reducing Cost

In recent years, the use of advanced imaging technologies has become a target for reducing LBP-associated expenses and unnecessary treatments. Though it may seem like a logical early step to prescribe an MRI for patients seeking to curb their LBP, there’s little evidence to support early imaging in uncomplicated cases.

One 2015 study compared pain- and function-related outcomes at the one-year mark for elderly patients who received early diagnostic imaging with a control group who did not.4 Neither the outcomes from the MRI/CT scan group nor the early radiograph group differed significantly from the outcomes of the control group in their assessment of their condition after 12 months via a disability questionnaire.

What’s more, several studies have linked early diagnostic imaging to a stark increase in patient utilization of surgery and injections. In one 2015 study, charges for the early diagnostic group were higher by an average of $4,793 than those that were instead referred to physical therapy for their LBP.

Despite this relatively new data and the recommendation of the American College of Radiology against imaging during the first six weeks of LBP, some physicians remain quick to guide patients toward MRI as early as the patient’s first visit for lower back dysfunction. While many cases will indeed eventually warrant imaging techniques in order to determine the best path forward, the data indicates that for uncomplicated LBP, physical therapy should often be the first line of treatment. This way, patients have the chance to eliminate pain in a low-cost, noninvasive manner before they prematurely resort to more expensive interventions.

Sources: 1 Childs JD, Fritz JM, Flynn TW, et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Services Research. 2015;(15):150. doi:

2 Driscoll T, Jacklyn G, Orchard J, et al. The global burden of occupationally related low back pain: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases. 2014;73(6):975-981. doi:10.1136/annrheumdis-2013-204631.

3 Fritz JM, Brennan GP, Hunter SJ. Physical Therapy or Advanced Imaging as First Management

Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges. Health Services Research. 2015;50(6):1927-1940. doi:10.1111/1475-6773.12301.

4 Jarvik JG, Gold LS, Comstock BA, Heagerty PJ, Rundell SD, Turner JA, Avins AL, Bauer Z, Bresnahan BW, Friedly JL, James K, Kessler L, Nedeljkovic SS, Nerenz DR, Shi X, Sullivan SD, Chan L, Schwalb JM, Deyo RA. Association of Early Imaging for Back Pain With Clinical Outcomes in Older Adults. JAMA. 2015;313(11):1143–1153. doi:10.1001/jama.2015.1871