Randomized trial finds therapies for spine pain improved quality of life but did not decrease health care spending

Pain in the back or the neck is extremely common and accounts for more health care spending than any other health condition. A study led by investigators from Brigham and Women's Hospital, a founding member of the Mass General Brigham health care system, compared two non-invasive interventions for treating spine pain, assessing both how well these methods worked at reducing pain and whether either method reduced spine-related health care spending.

In a clinical trial of 2,971 participants, patients with spine pain were randomized to receive usual care or one of two interventions. The first intervention used the identify, coordinate and enhance (ICE) model, in which patients receive specialized counseling, physical therapy and a specialist in pain medicine or psychiatry consults with their primary care physician. The second intervention was individualized postural therapy (IPT), a technique that attempts to realign and rebalance spinal muscles to relieve pain.

Compared to usual care, both interventions provided a small but significant improvement in pain-related disability after three months. These changes were sustained and clinically meaningful at 12 months, long after the interventions were over. Both interventions reduced resource utilization (such as diagnostic imaging, procedures, and specialist visits).

Overall, the ICE intervention lowered spine-related spending by $139 per person compared to usual care (p=0.04), although this difference was not statically significant at the threshold used in the trial. Spine-related spending for the IPT intervention was significantly higher than usual care.

"Both methods examined in this clinical trial led to small but meaningful reductions in pain-related disability," said corresponding author Niteesh Choudhry, MD, Ph.D., executive director for BWH's Center for Healthcare Delivery Sciences and a practicing hospitalist. "Given the high cost of spine-related health care spending, it is critically important to find cost-effective ways to effectively improve pain management."

The study is published in the journal JAMA.