Pain in the back or the neck is extremely common and accounts for more healthcare 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 healthcare 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 healthcare 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, PhD, executive director for BWH’s Center for Healthcare Delivery Sciences and a practicing hospitalist. “Given the high cost of spine-related healthcare spending, it is critically important to find cost-effective ways to effectively improve pain management.”
Read more in JAMA .
JAMA
Randomized controlled/clinical trial
People
Effect of a Biopsychosocial Intervention or Postural Therapy on Disability and Health Care Spending Among Patients With Acute and Subacute Spine Pain
20-Dec-2022
Dr Choudhry reported receiving grants from Stanford University during the conduct of the study. Dr Fifer reported receiving grants from Stanford University during the conduct of the study. Dr Archer reported receiving grants from Stanford during the conduct of the study; receiving personal fees from Spine and NeuroSpinal Innovation Inc outside the submitted work; and being a past consultant for Pacira and NeuroPoint Alliance. Dr Haff reported receiving grants from Stanford University to Brigham and Women’s Hospital during the conduct of the study. Dr Schneider reported receiving grants from VUMC during the conduct of the study; receiving grants from Spine Intervention Society and personal fees from State Farm and AIM Specialty outside the submitted work; and serving as a board member of the Spine Intervention Society. Dr Butterworth reported receiving personal fees from Stanford University during the conduct of the study and receiving personal fees for motivational interviewing training from UPMC Health Plan, University of Michigan School of Nursing, PacificSource Health Plan, Independence Care System, Purchaser Business Group on Health, University of Utah, and RGA outside the submitted work. Dr Cooper reported receiving grants from HonorHealth Research Institute during the conduct of the study. Dr Hsu reported full-time employment with Elevance Health (formerly Anthem Inc), a national health insurance organization, as regional vice president, Medicare.Ms Davidson reported receiving grants from Vanderbilt University Medical Center during the conduct of the study. Dr Milstein reported investment in EZPT, a consumer wellness company, outside the submitted work and funding from unrestricted philanthropic gifts to his employer, Stanford University. Dr Crum reported receiving grants from Stanford University during the conduct of the study. No other disclosures were reported.