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Nondrug and nonsurgical treatments for low back pain, including psychological support, exercise and self-management strategies, are cost-effective interventions, according to a study published Oct. 27 in the journal PLOS Medicine by Manuela Loureiro Ferreira from the George Institute for Global Health, Australia, and colleagues.

Low back pain is the leading cause of disability worldwide, with significant costs to both individuals and health care systems. There are pharmacological or surgical interventions—including drug prescriptions, spinal injections and surgery—but noninvasive methods such as cognitive therapy, physical therapy, exercise and yoga or dietary interventions are also available. Understanding which options provide the best value for the money is important for determining where to allocate health care funding.

To better understand the cost-effectiveness of noninvasive interventions for low back pain, the authors of this study reviewed research studying treatments recommended by the World Health Organization, the United Kingdom's National Institute for Health and Care Excellence (NICE), and the North American Spine Society.

They included 20 studies conducted between 2005 and 2026, with a total of 14,884 participants. Those studies compared nonpharmacological and nonsurgical interventions such as yoga, acupuncture, massage, psychological therapy, spinal manipulation, exercise and diet plans to some first-contact care or no treatment.

The authors found that five single therapies—yoga, cognitive behavioral therapy, self-management support, fear reduction education and mindfulness stress reduction—could reduce health care costs and improve outcomes compared with usual care.

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