Yoga, therapy and self-care offer good value in low back pain care

Many non-drug and non-surgical treatments for low back pain are cost-effective, according to a systematic review published October 27 in the open access journal PLOS Medicine by Manuela Loureiro Ferreira of the George Institute for Global Health, Australia, and colleagues.

Low back pain is the leading cause of disability worldwide, imposing significant costs on both individuals and healthcare systems. While pharmacological and surgical options exist—including drug prescriptions, spinal injections and surgery—non-invasive approaches such as cognitive therapy, physical therapy, exercise, yoga and dietary interventions are also available. Understanding which options provide the best value for money is important for deciding where to allocate healthcare funding.

To assess the cost-effectiveness of non-invasive interventions, the researchers reviewed studies of 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 non-pharmacological and non-surgical interventions such as yoga, acupuncture, massage, psychological therapy, spinal manipulation, exercise and diet plans against some form of first contact care or no treatment.

The review found that six single therapies—yoga, cognitive behavioral therapy, self-management support, fear reduction education and mindfulness stress reduction—could reduce healthcare costs and improve outcomes compared with usual care. The authors also observed that two multi-modal 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 their costs fell below that maximum price, a threshold recommended by NICE.

Senior author Professor Manuela Ferreira said: “Low back pain is the world’s leading cause of disability, but many effective treatments can also save healthcare 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,” she added.

The authors noted important limitations. All of the studies examined were conducted in high-income countries, and there were differences in how cost-effectiveness was measured across the included research. Despite these limitations, the authors suggest that improving access to these non-surgical and non-pharmacological treatments could benefit patients with low back pain.

The findings come from a peer-reviewed systematic review published in PLOS Medicine, with authors based in Australia and the United Kingdom. The work received no specific funding, and the published manuscript lists any competing interests. The paper, titled “Cost-effectiveness of recommended interventions for managing low back pain: A systematic review,” is freely available to readers.

Subject of Research: Cost-effectiveness of non-drug and non-surgical interventions for low back pain

Article Title: Many non-drug and non-surgical therapies for low back pain are cost-effective

Article References: Many non-drug and non-surgical therapies for low back pain are cost-effective. Original publication (Bibliographic details unavailable.)

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Keywords: low back pain, cost-effectiveness, systematic review, yoga, cognitive behavioral therapy, exercise, self-management, PLOS Medicine, health economics, NICE threshold, non-pharmacological treatment, disability