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Utah study: Early physical therapy can ease lower back pain

Published April 26, 2013 11:48 am

Public health • Researchers challenge prevailing wisdom that intervention is a waste of time, money.
This is an archived article that was published on sltrib.com in 2013, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Lower back pain is ubiquitous. Just about everybody gets it at some point in time.

And, contrary to conventional belief, early intervention by a physical therapist may be appropriate for some patients, according to researchers at Intermountain Healthcare.

"It's likely there's a group of patients who could benefit from early physical therapy. It's not everyone, and we need to examine that further. But using it doesn't automatically jack up costs," said Julie Fritz, physical therapist and clinical outcomes research scientist at Intermountain Healthcare.

Working with scientists at the University of Utah, Fritz examined electronic medical records and insurance claims of 2,184 patients who visited a primary care doctor for low back pain between 2004 and 2008 to determine which course of treatment was most cost-effective in the long run.

Results were published in the Archives of Physical Medicine and Rehabilitation.

Back pain is the second most common neurological ailment in the U.S., surpassed only by headaches, according to the National Institutes of Health (NIH). It is the most common job-related disability and leading contributor to missed work.

Low back pain can signal other health problems, such as a kidney stone or urinary tract infection. But most cases resolve on their own and are easily managed with over-the-counter pain relievers, said Fritz, noting there's debate about the value of early physical therapy.

Most family doctors prescribe therapy only if the pain persists for several weeks, said Fritz. "The argument is that intervening early with physical therapy is either a waste of time or it could add costs or cause harm."

Those arguing for physical therapy note that while most patients improve quickly, full recovery is elusive, recurrence is common and early treatment may be best for alleviating chronic pain, she said. "Once it becomes chronic it becomes increasingly difficult to get rid of it."

Researchers whittled the 2,184 back patients to a list of 286 who sought physical therapy within 14 days and compared their costs to those who underwent other forms of treatment.

"We found cost drivers, but it wasn't physical therapy," said Fritz.

At higher risk for "higher utilization" of care, such as epidural injections and surgery, were patients of advanced age, those with mental health problems and neck pain and those treated with opioids, the study showed.

"Physical therapy, at least for some patients, is a good option for avoiding future back pain," said Fritz. "Which patients, and how big of a group? We need to research that further."