Cost Analysis Related to Dose-response of SMT for Chronic Low Back Pain
Written by Editor   
Wednesday, December 07, 2016 12:00 AM

News Bite: This study in examining the incremental costs and benefits of different doses of SMT for chronic LBP found that while all patients receiving SMT had more pain-free and disability-free days compared with the control group, those who received a dose of 12 SMT treatments over a six week period demonstrated a statistically significant number of pain-free and disability-free days.  Care of chronic LBP with SMT did not increase the costs of treatment plus lost productivity.


The estimated incidence of moderate back pain is 10–15% of the adult population. Low back pain is the 5th most common reason for physician office visits in the US. Amongst people with LBP, who see a complementary and alternative medicine (CAM) practitioner for any reason, approximately 49% see a doctor of chiropractic for LBP.  The use of CAM, including chiropractic care, has increased significantly over the past 50 years, and may be associated with lower treatment costs. 

The purpose of this study’s analysis is to report the incremental costs and benefits of different doses of spinal manipulative therapy (SMT) in patients with chronic low back pain (LBP).  A dose of 12 SMT sessions yielded a modest benefit in pain-free and disability-free days. Care of chronic LBP with SMT did not increase the costs of treatment plus lost productivity.

Participants were assigned to receive 3 treatments per week for 6 weeks. The researchers randomized a total of 400 participants to receive a dose of 0, 6, 12, or 18 SMT sessions out of the total 18 treatment visits with a doctor of chiropractic. Treating physicians provided care at each visit: SMT or a minimal light massage control to isolate the effect of SMT from the effect of touching the patient therapeutically. 

Societal costs in the year after study enrollment were estimated using patient reports of health care use and lost productivity. The main health outcomes were the number of pain-free days and disability-free days.  Lost productivity accounts for most societal costs of chronic LBP. The cost of treatment and lost productivity ranged from $3398 for those who received 12 SMT sessions to $3815 for those receiving 0 SMT sessions.  There were no statistically significant differences between groups. Baseline patient characteristics related to increase in costs were greater age, greater disability, lower quality-adjusted life year scores, and higher costs in the period preceding enrollment. 

Pain-free and disability-free days were greater for all SMT doses compared with control, but only SMT 12 yielded a statistically significant benefit of 22.9 pain-free days and 19.8 disability-free days.