Common back-pain therapy may work—but it doesn’t save on imaging or other costs

Judging by thousands of insurance claims, spinal manipulation does little to tamp down the overall costs of treating low-back pain. Further, the popular therapy is often preceded by costly and unnecessary imaging exams.

German researchers made the findings after identifying more than 113,000 adult patients who presented with acute low-back pain. Of these, 21,021 (18 percent) received spinal manual therapy (SMT) from a physician.

After excluding patients fulfilling exclusion criteria, such as pain in the cervical or thoracic spine or chronic back pain, the researchers matched 17,965 patients into SMT and no-SMT groups.

Senior study author Jean-François Chenot, MD, MPH, of the University of Greifswald and colleagues report that the provision of SMT for acute low-back pain had no relevant impact on number of follow-up visits, days of sick leave or other outcomes indicators.  

Meanwhile SMT was associated with a higher proportion of imaging studies for low-back pain—and it did not lead to meaningful savings by replacing other health services for low-back pain.  

“This does not imply that SMT is ineffective but might reflect a problem with selection of suitable patients and the quality and quantity of SMT in routine care,” the authors write.

Medical societies involved with manual medicine “should state clearly that imaging is not routinely needed prior to SMT in patients with low suspicion of presence of red flags,” and practitioners should “monitor the quality of provided services,” Chenot et al. conclude.

The study was published online May 15 in PLoS One. It’s available in full for free.