Influence of Active, Passive & Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization

woman with lower back pain

Should we combine active and passive interventions for low back pain? Is spinal manipulation an active or passive therapy, or both?

A variety of treatments offered by chiropractors and physical therapists are commonly recommended in clinical practice guidelines (CPGs) as a first line of treatment for patients with LBP. However, there are many types of interventions utilized by clinicians which are provided in differing combinations. Some of these interventions may offer little to no health benefits, resulting in costly and often suboptimal outcomes. Evidence-informed best practices are therefore needed to improve care for patients with LBP.  

Several CPGs have been developed for the management of patients with LBP which have consistently recommended the use of active interventions, like physical activity and exercise therapy, as essential interventions for acute and chronic LBP. Treatment approaches that focus mainly on the use of passive interventions (ex. hot or cold packs, electrical stimulation and mechanical traction) or the overuse of active interventions often lead to worse clinical outcomes and excessive downstream health care utilization and costs.

Manual therapy, including spinal mobilization and manipulation, is considered a passive intervention by some, although it is recommended by most CPGs for the management of both acute and chronic LBP. Furthermore, manual therapy typically includes active participation of the patient through specific tailored active movements and reinforcing exercises. It has been suggested that the use of passive interventions may enable patient participation in an active intervention program, although very little evidence is available to support that concept.

Given the lack of evidence in this area, the objective of this current study was to investigate the relationships between the use of active, passive, and manual therapy interventions for the management of patients with LBP and the following 1-year escalation-of-care events, including opioid prescriptions, spinal injections, specialty care visits, and hospitalizations.

This week’s Research Review: “Influence of Active, Passive & Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization

This paper was published in Physical Therapy (2024)

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