Low Back Pain

  • A 2018 cross-sectional study of insurance plans that together represented over half the U.S. population examined coverage policies for 5 nonpharmacologic approaches commonly used to treat acute or chronic low back pain among commercial and Medicare Advantage insurance plans, plus an additional 6 treatments among Medicaid plans. Payers most commonly covered physical therapy (98%), occupational therapy (96%), and chiropractic care (89%).1
  • A 2017 systematic review found that combined physical and psychological treatments, medical yoga, information and education programs, spinal manipulation and acupuncture are likely to be cost-effective options for LBP.2

Knee Osteoarthritis

  • A 2018 randomized controlled trial found that spacing exercise-based physical therapy sessions over 12 months using periodic booster sessions was less costly and more effective over 2 years than strategies not containing booster sessions for individuals with knee OA.3
  • A 2017 systematic review estimated the costs and benefits of acupuncture, braces, heat treatment, insoles, interferential therapy, laser/light therapy, manual therapy, neuromuscular electrical stimulation, pulsed electrical stimulation, pulsed electromagnetic fields, static magnets and transcutaneous electrical nerve stimulation (TENS) for knee osteoarthritis using data from 88 randomized controlled trials including 7,507 patients. TENS and acupuncture were found to be cost-effective.4

Carpal Tunnel Syndrome

  • A 2019 randomized controlled trial found that manual physical therapy, including desensitization maneuvers of the central nervous system, has been found to be equally effective but less costly (ie, more cost-effective) than surgery for women with CTS.5

Chronic Musculoskeletal Pain in U.S. Veterans

  • A 2019 study used a propensity score-adjusted hierarchical linear modeling (HLM), and 2010-2013 VA administrative data to estimate differences in VA healthcare costs, pain intensity, and opioid use between Complementary and Integrative Healthcare users and nonusers. CIH use appears associated with lower healthcare costs and pain and slightly higher opioid use in this population of younger veterans with chronic musculoskeletal pain.6


  1. Heyward J, Jones CM, Compton WM, et al. Coverage of nonpharmacologic treatments for low back pain among US public and private insurers. JAMA Network Open. 2018;1(6):e183044. FREE FULL TEXT
  2. Andronis L, Kinghorn P, Qiao S, Whitehurst DG, Durrell S, McLeod H. Cost-effectiveness of non-invasive and non-pharmacological interventions for low back pain: a systematic literature review. Applied Health Econ Health Policy. 2017;15(2):173-201
  3. Bove AM, Smith KJ, Bise CG, et al. Exercise, manual therapy, and booster sessions in knee osteoarthritis: cost-effectiveness analysis from a multicenter randomized controlled trial. Phys Ther. 2018;98(1):16-27. FREE FULL TEXT
  4. Woods B, Manca A, Weatherly H, et al. Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PloS One. 2017;12(3):e0172749. FREE FULL TEXT
  5. Fernandez-de-Las-Penas C, Ortega-Santiago R, Diaz HF, et al. Cost-effectiveness evaluation of manual physical therapy versus surgery for carpal tunnel syndrome: evidence from a randomized clinical trial. J Orthop Sports Phys Ther. 2019;49(2):55-63. FREE FULL TEXT
  6. Herman PM, Yuan AH, Cefalu MS, et al. The use of complementary and integrative health approaches for chronic musculoskeletal pain in younger US Veterans