Study suggests doctors may not be the best first option for low back pain

Two studies out of the University of Washington say seeing a doctor may not be the best first option for low back pain. Both studies show that decreased activity, opioids, and surgery don’t work for most patients. Here’s what these experts suggest instead.

Bianca Frogner, PhD, a Director at Center for Health Workforce Studies and Associate Professor in the Department of Family Medicine at University of Washington was moving boxes into this new house, when she said, “My legs just kind of buckled out from under me, and I just felt this excruciating pain going from my back down to my legs.”

Her team had analyzed 150,000 insurance claims and found that patients who saw a physical therapist first for low back pain lowered their probability of getting opioids prescribed by 89 percent, advanced imaging by 28 percent, and an emergency room visit by 15 percent.

Professor Frogner told Ivanhoe, “A physical therapist is telling you to move your body in certain ways, and it seems almost too easy that the only thing you need to do is stretch.”
Physical therapy worked for her, without drugs or a doctor.

Pain management specialist Judith A. Turner, PhD, a Professor at University of Washington School of Medicine and President at International Association of the Study of Pain reviewed many studies and found that surgery is not indicated for most low back pain problems.

“All too often, people get the advice to stop everything that they’re doing, rest, take some opioid medication. And, we know now that’s the wrong treatment,” explained Professor Turner.
Instead, she found most people responded better to exercise and cognitive behavior therapy like relaxation and pain-coping skills that train the brain to respond differently. Professor Frogner said insurance coverage often dictates what treatment people receive for pain.

She also stated, “I think there just needs to be more studies to understand whether we’re really incentivizing patients to see the best provider for the kind of care they need.”
Professor Frogner said people in all 50 states have the right to see a physical therapist without a doctor referral but their insurance policy may require doctor referrals. Many patients don’t take advantage of this because their insurance copays may be higher for a physical therapist than for a doctor.