The Cost-Effectiveness of Nonpharmacological Interventions for Pain

February 21, 2022

With first-line treatments changing, back pain does not need to be a fact of life.

Article was written by WholeHealth Living

Five years ago, the American College of Physicians (ACP) published new nondrug guidelines for treating chronic or recurrent back pain. This condition afflicts approximately 25% of adults at more than $100 billion a year.1

Dr. Nitin Damle, president of the ACP at the time and a practicing internist, said pills, even over-the-counter pain relievers, and anti-inflammatories, should not be the first choice. He told the New York Times, “We need to look at therapies that are nonpharmacological first,” he said. “That is a change.”2

The new guidelines discouraged opioid painkillers for back pain and suggested that patients try alternative therapies like exercise, acupuncture, massage therapy, or yoga. The ACP also said that doctors should reassure patients that they will get better no matter the treatment.

Unfortunately, even after five years, it’s still an uphill climb. Various structural incentives push doctors and patients toward ineffective medications, scans, and injections that increase the cost of care.

Dr. Rick Deyo, a spine researcher and an author of the new guidelines, told the New York Times, “There is marketing from professional organizations and from industry [who are saying], we have the cure. You can expect to be cured. You can expect to be pain-free.”3 However, patients are still experiencing pain because most health plans don’t pay for a range of nonpharmacologic therapies.

Bringing Integrative Therapies to Health Plan Members

WholeHealth Living is a leader in providing access to Physical Medicine and Integrative Health solutions for health plan members. WholeHealth Living promotes nonpharmacologic options because they are less invasive, less expensive, pose a lower risk than drugs or surgery with reduced opioid use.

“We recognize that musculoskeletal conditions are a major contributor to medical spend,” said Maria Granzotti, Chief Medical Officer of WholeHealth Living. “For this reason, we are committed to making nonpharmacologic solutions available that support high-quality, medically necessary care while decreasing overall healthcare costs.”

Cost-Effectiveness: The Results are in

The goal in managing utilization is to prescribe the right care at the right time. Reality is more complex, though. How do you prescribe cost-effective care when patients step into a funnel of escalating care – from an ER visit to high-tech imaging, an opioid prescription, and even surgery – followed by weeks of rehabilitation.

Given these high-dollar stakes, several studies looked to see if non-invasive and nonpharmacologic interventions are cost-effective:

  • 2017, Literature Review | A systematic review of 33 studies sought to determine the cost-effectiveness of nonpharmacologic interventions to alleviate lower back pain. The study concluded that a combination of physical and psychological treatments, medical yoga, information and education programs, spinal manipulation, and acupuncture are likely to relieve lower back pain cost-effectively.4
  • 2017, Timing of therapy | This study looked at the cost-effectiveness of nonpharmacologic options based on timing. The study calculated the total average spending for integrative therapies versus injections and surgery.
    • Therapies as first treatments:  The cost of therapy as the first line of care was 19% less than if injections were given initially and 75% less if surgery was presented first.
    • Year-one following diagnosis: The cost after one year was 18% less than if injections were given first and 54% less than if surgery was offered first.
    • Timing and Downstream costs: Members who received therapy within the first 15 days of a diagnosis accrued downstream costs that were 27% lower than patients who received therapies between 45 to 90 days after the diagnosis.5
  • 2019, Including Chiropractic – A study looking at the cost-effectiveness of chiropractic care with Medicaid patients in Missouri determined that “there would be cost savings to the state between $14.1 and $49.2 million. The study also concluded that chiropractic [care] for neck and lower back pain might reduce the use and abuse of opioid prescription drugs.”6

Managing Big-Ticket Costs

Unfortunately, an MRI scan is still generally considered the standard of care to help plan treatment for back pain. The scans are used for pre-surgical planning for a decompression or a lumbar spinal fusion. MRI scans are sensitive enough to see the health of the discs and the presence of any spinal tumors or herniated discs that might be causing back pain. On the downside, a spinal MRI can cost between $1,000 and $5,000, with hospital sites being at the higher end.

The ACP authors of the back-pain guidelines found MRIs for back-pain diagnosis to be “worse than useless.”7 The images can be misleading, showing abnormalities that may not be related to the pain. The bottom line, an MRI often adds nothing to a diagnosis or recovery. The main thing is to keep active –through physical therapy, yoga, or with the support of massage and chiropractic care.

Another study found traditional treatments might be no more effective than a placebo:

  • In a 2016 study, patients with chronic low back pain were offered a placebo (and told it was a placebo) in conjunction with their normal ibuprofen or naproxen. A second group did not receive the placebo. Those taking the placebo reported less pain and disability than those in the control group who did not take it.8

The challenge with all treatments is that people with chronic back pain tend to avoid activity out of a fear of making their medical condition worse. In all cases, having a trusted physical medicine practitioner to guide the patient’s return to movement safely can help them set goals, return to an active life, and manage their pain effectively.

Utilization Management

Health plans used to rigorous Utilization Management often see alternative therapies or Physical Medicine and Integrative Health solutions as the unregulated “Wild West” of healthcare. WholeHealth Living overturns the traditional mindset by delivering the same rigor for clinical oversight applied in traditional healthcare. Utilization management ensures clinically appropriate care grounded in evidence-based best practices, supported by data analytics, practitioner engagement, and education.

This approach ensures that care is clinically indicated and medically necessary. WholeHealth Living’s Chiropractic Utilization Management program consistently delivers savings ranging from a 2:1 to a 5:1 return on investment.

Next Steps

To learn more about WholeHealth Living and its proven ability to mitigate pain while delivering measurable savings, visit