Background/Purpose:

Low back pain (LBP) affects 67% to 84% of persons residing in industrialized countries, and is a significant source of lost productivity, disability, and increased health care costs (treatment costs estimated at $90 billion).  Both pharmacologic (i.e., opioids-“fair” evidence to support use) and non-pharmacologic (i.e., exercise therapy-“good” evidence) treatments are recommended for LBP management. Because the prevalence of LBP and opioids use (p=.0014) differs between the U.S. Census Regions, we compared the treatments used for LBP and their related costs between regions.

Methods:

De-identified patient health claims data from persons with LBP (ICD-9 codes-724.2 [lumbago]) along with treatments received (CPT codes-97001 [physical therapy {PT}]) and medication records was extracted from a large commercially insured dataset (January 1, 2007-December 31, 2009) (N=1,630,438). After using descriptive statistics to describe the sample and the frequency of received LBP treatments, we used Pearson’s Chi-Squared Test of Independence to compare therapy and medication usages among the different regions.

Results:

An opioid was used by 49.8% (n=812,479) of this sample while nonpharmacologic therapies were rarely used (8%-psychological therapies; 19%- exercise therapies; 12%-PT). Opioids had the lowest standardized cost ($16); anti-convulsants (n=49,073) had the highest standardized cost ($452). The median costs for non-pharmacologic treatments are variable ($5,526-surgical procedures vs. $40-hot/cold packs). We found significant differences in the medications and therapies used in the U.S. Census Regions (p < .0001; Figure 1).

Conclusion:

There is a lack of adherence to treatment recommendations for LBP and significant differences in the receipt of various LBP treatments per U.S. Census Region. Further research is needed to explore this discrepancy.