Low back pain: non-drug treatments appear cost-effective, with no universal ranking

What the researchers compared

The authors searched ten databases up to 9 February 2026 for economic evaluations of treatments recommended by clinical guidelines for non-specific low back pain. Their review includes 17 trial-based evaluations and three modelling studies.

Half of the studies focused on chronic pain lasting more than three months. Another eight included populations with a mix of acute, subacute and chronic low back pain. Some interventions combined several components, such as exercise and spinal manipulation.

The primary outcome was cost per quality-adjusted life year, or QALY. This measure relates spending to health benefits. Amounts were converted to 2024 pounds sterling, and the findings were then synthesised qualitatively.

Cost-effective does not necessarily mean cost-saving

According to the abstract, most interventions were cost-effective at a threshold of £20,000 per QALY. This means neither that they cost less nor that this amount is the price of a treatment. An intervention may be considered cost-effective if its health benefit justifies its additional cost at the chosen threshold.

Some programmes also appeared potentially cost-saving: they were both more effective and less costly than usual care in the relevant evaluations. The abstract mentions interventions targeting fear and stress, self-management support, and approaches involving yoga, acupuncture or cognitive therapy.

However, these findings do not establish a ranking of these approaches. The abstract does not report the size of the savings or clinical benefits for each one.

What this means for choosing care

This review supports the economic value of care incorporating education, psychological support or exercise, rather than relying solely on the usual care described in the studies, such as advice and medication.

When choosing care, however, you need to distinguish its value to a healthcare system from its value in your own situation. All the studies come from high-income countries, and the evidence is highly heterogeneous. Currency conversion alone cannot establish the cost, reimbursement or accessibility of these treatments in France.

What we can take away

Several non-drug approaches to low back pain appear to offer good economic value compared with usual care. This review demonstrates neither their equivalence nor the superiority of any one method for a given person.