Francesca Galiano
23/06/2022 - Last update 30/12/2022

Danielle Cooley, James Bailey, Richard Jermyn | Year 2021

Cost comparison of osteopathic manipulative treatment for patients with chronic low back pain


Low back pain

Type of study:

Prospective observational study

Date of publication of the study’:



Purpose of the study

  • Objective: to assess healthcare costs related to the management of chronic low back pain by comparing standard of care treatment with the addition of OMT to standard of care treatment only
  • Measured outcomes:
    • Primary: the average total healthcare costs ($) incurred by each patient during the period of the study
    • Secondary: use of health services (eg, surgery, x-rays, medication, physiotherapy)


  • Number: 146 people (108 female and 38 male)
  • Criteria of inclusion: age 18-84 years, diagnosed with chronic low back pain for more than 3 months (confirmed by the following ICD-10 codes: M54.5, M54.16, G57.01, G57.02, M48.062, M48.062, M47.816, M48.07, M54.41, M54.42) and treated at the School of Osteopathic Medicine at the Rowan University of New Jersey, the Pain Associates Center of New Jersey and the Michigan State University.
  • Criteria of exclusion: history or presence of diabetic neuropathy, lumbar or sacral congenital abnormalities, lumbar fractures, multiple myeloma, bone metastases, spinal surgery or low back pain from less than 3 months prior to the study.
  • Groups of study: two groups obtained on the basis of the specialization of the therapist who followed the individual subjects
    • Group 1: standard of care with the addition of OMT, 71 individuals (59 female and 12 male, mean age 58 years)
    • Group 2: only standard of care, 75 individuals (49 female and 26 male, mean age 54 years)

Interventions and evaluations

  • Assessment of pain on the Pain Intensity Numerical Rating Scale (PI-NRS) and disability on the Roland Morris Disability Questionnaire (RMDQ) at the beginning and at the end of the study
  • Data on health expenses were acquired through medical records analysis
  • Every patient was followed for 4 months
  • Standard of care: pharmacological prescription (opioids, non-steroidal anti-inflammatory and muscle relaxant drugs), steroid injections, diagnostic imaging, physiotherapy, psychotherapy, neurostimulators of the spinal cord, insertion of spinal pumps and other therapies
  • Standard of care with the addition of OMT: standard of care with OMT tailored to the patient


  • Primary outcomes: the difference in healthcare costs between the two groups was not significant from a statistical point of view, despite the fact that the standard of care group with the addition of OMT reported a lower total average expenditure (831$ against 998$).
  • Secondary outcomes: the use of health services was significantly lower in the group that followed standard care with the addition of OMT than those who followed only standard of care. In the OMT group only 1 person out of 50 used interventional therapies (e.g. surgery), compared to 2 people out of 5 in the other group, and only 1 person out of 20 required radiological investigations, compared to 1 person out of 5 in the other group.

Furthermore, people who were treated with osteopathy received fewer opioids than those who were not (1 person in 5 versus 1 person in 2).

While both groups saw a statistically significant reduction in disability measured on the RMDQ, only the group with standard of care witnessed a statistically significant decrease in pain measured on the PI-NRS, although the extent of the decrease was the same in both groups.There were no differences between the two groups in consulting any specialists, in the use of physiotherapy or drugs in general


Although there is no significant difference in costs incurred between the two groups, the results can be considered encouraging as they show that there is no difference despite, compared to standard of care, a group also had to bear the osteopath’s costs. Moreover, the group with OMT, which however had an average health expenditure lower than the other group (831$ against 998$), reported a minor use of other health services. This event explains why, despite the addition of the expense for the osteopathic visit, the costs were not higher in the group with OMT, but rather they were slightly lower.

In fact, this group has used significantly fewer interventional therapies such as surgery, which are very expensive (the group with standard of care only spent on average 2400$ for these interventions, against only 175$ in the group that also received the OMT).

Most likely, there are two reasons for this: on the one hand, since osteopaths tend to perform a very thorough analysis of the anatomical state of health, there is a greater probability to identify possible dysfunctions without any radiological examinations.

• On the other hand, following an osteopathic treatment, there is a tendency to evaluate the effect of OMT before resorting to surgery or other therapies, which however present a series of risks inherent in being interventional therapie.


The same can be said for the reduction, which also occurred in the group with OMT added to standard care, in the use of opioids, whose side effects both organic and of hormonal alteration are strongly manifested in case of abuse or continuous use. Finally, according to the analyses carried out, neither sex nor age seem to have influenced the results of the study, thus suggesting that the decrease in costs and services such as surgery and radiographic diagnosis can be considered linked to the effectiveness of the OMT.

The review of Osteopedia

By Marco Chiera

Strengths: one of the first studies to show the economic impact that OMT can have, in addition to standard of care, in managing patients with chronic low back pain; one of the first studies to show how OMT can indirectly influence costs by reducing the use of other health services. Considering that the current scientific evidence reports an extremely low usefulness of surgery in case of non-specific chronic low back pain (that is, without any specific pathological cause such as fractures or tumors), the result of this study emphasizes the importance of looking at other therapies, such as osteopathy.

Limits: The study was performed on a particularly homogeneous population (mainly white women between 40 and 60 years of age) and only for 4 months, without checking what happened after the study had ended. In addition, more people would be needed to better assess the health costs incurred.

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