Many nondrug and nonsurgical therapies for low back pain are more cost-effective than usual care
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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.
They also observed that two multimodal therapies—combining advice and graded activity in the workplace, and diet plus physical activity—were more cost-effective than usual care, at a willingness-to-pay threshold of £20,000 (meaning that costs were below that maximum price, a threshold recommended by NICE).
While all of the studies examined were from high-income countries and there were differences in how cost-effectiveness was measured, the authors suggest that improving access to these nonsurgical and nonpharmacological treatments could benefit patients with low back pain.
Senior author Ferreira adds, "Low back pain is the world's leading cause of disability, but many effective treatments can also save health care dollars. Our review found that approaches such as exercise, yoga, acupuncture and psychological support can help people recover while providing good value for money.
"The good news for people with back pain is that some of the most effective treatments are also among the most cost-effective. Investing in evidence-based care such as exercise, physical therapies and psychological support could help more people get better while reducing pressure on health systems."
Publication details
Mathieson S, Underwood M, Ibrahim M, Hua Z, Zhu Z, Ferreira PH, et al. (2026) Cost-effectiveness of recommended interventions for managing low back pain: A systematic review. PLOS Medicine (2026). DOI: 10.1371/journal.pmed.1005273
Journal information: PLoS Medicine
Key medical concepts
Low Back PainCognitive Behavioral Therapyyoga
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