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For Low Back Pain, Physical Therapy First Is Safer And Less Expensive

Low back pain is one of the most common reasons to seek medical care. Although clinical guidelines for medical best practices promote the use of nonpharmacologic therapies (including spinal manipulation, exercise, interdisciplinary rehabilitation, and cognitive-behavioral therapy) for back pain, there is an overuse of pharmacological treatments for low back pain.

Since the late 1990’s, overdose death rates, prescriptions, sales, and substance abuse treatment admissions related to opioid pain relievers have all increased substantially and are continuing to rise. A recent retrospective analysis compared differences in opioid prescription rates, health care utilization, and costs among patients with low back pain who saw a physical therapist as their first point of care, at any time during the episode, or not at all.1 This study found a 90% lower probability of being prescribed an opioid as well as lower rates of emergency room utilization (15%), and less use of imaging (28%) in those that pursued physical therapy first. Another study looking at healthcare cost, utilization and imaging found that in cases of non-specific low back pain (absence of trauma, findings suggestive of cancer or infection, or rapidly progressing neurologic deficits), seeing a physical therapist first may decrease future health care costs and decrease exposure to more invasive procedures.2

While scheduling a visit with your physician may be your first thought upon developing low back pain, keep in mind that seeing a physical therapist first may reduce the future need for more costly or invasive health care services. Colorado is a classified as a direct access state, meaning that patients can see a physical therapist without a prescription or referral from a physician. However, some insurers or insurance plans may require an individual to obtain a referral before seeing a physical therapist- check your benefits or call your insurer to find out.


1. Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. 2018. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Services Research.

2. Fritz JM, Brennan GP, Hunter SJ. 2015. 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 50:6: 1927-1940


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