Unmet Needs

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Lead Author(s): 

Kern Singh, MD
Gunnar Andersson, MD, PhD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

There remains debate regarding the most effective treatment for low back pain. In systematic review performed by Zaina et al, the authors evaluated the effectiveness of different types of surgery compared with different types of non-surgical intervention in the treatment of low back pain secondary to lumbar spinal stenosis (LSS).1 The authors’ analysis demonstrated no differences in pain-related disability improvement between surgical (decompression with or without fusion) and non-surgical care. However, due to the low quality of available studies, the authors were unable to confidently recommend a preferable treatment method for symptomatic LSS.

There has also been increasing research on the efficacy of non-surgical interventions for low back pain. Ammendolia et al investigated the safety and effectiveness of epidural injections to other treatments for symptomatic LSS.2 Due to the low overall evidence (only 4 randomized controlled trials), the authors were only able to conclude that epidural injections provide improved pain, function, and quality of life for only up to 2 weeks.

Acupuncture has been utilized in the treatment of low back pain for centuries, and has recently been established as a non-operative complimentary treatment in the United States.3 A meta-analysis evaluating the use of acupuncture in the treatment of low back demonstrated that the use of acupuncture as a complimentary treatment to be highly cost-effective.4 According to the world health organization (WHO) cost-effectiveness threshold values, the cost of complimentary acupuncture treatment was determined to be $48,562 per disabilty-adjusted life year (DALY) avoided. Interestingly, in patients where comorbid depression was also alleviated at the same rate as pain, the cost was revealed to be $18,960 per DALY avoided. The authors concluded that acupuncture as a substitute for standard care was most cost-effective when used in patients with comorbid depression.

As noted in the discussion above (Indirect Costs), back pain was the cause of close to 264 million lost work days in a 12 month period during 2014/2015. In addition, over 4%, or 1 in 25, persons in the prime working ages of 18 to 64 report they are either limited in the type or amount of work they can do or are unable to work at all due to back pain. It is clear that back pain has a substantial impact on the workforce, and that finding ways to reduce or repair causes of back pain is needed. (Reference Table 2A.11.2 PDF CSV)

  • 1. Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016(1):CD010264.
  • 2. Ammendolia C, Stuber KJ, Rok E, et al. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev. 2013(8):CD010712.
  • 3. Chao R, Qaseem A, Snow V, et al. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society Ann Intern Med. 2007;147(7):478-491.
  • 4. Taylor P, Pezzullo L, Grant SJ, Bensoussan A. Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain. Pain Pract. 2014;14(7):599-606.


  • Fourth Edition

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