I just saw a little blip on the web that flashed by too fast to read the details. It said that the U.S. is spending billions of dollars on spine care every year. I’ve spent a boatload myself on radiologists, chiropractors, orthopedists, physical therapists, massage therapists, acupuncturists — you name it, I’ve spent money on it. How are other people saving money on their back care? What can I do to reduce my out-of-pocket expenses?

You are asking a good question and one that will be of interest to many other people. Up to 80 per cent of all adults will have back pain at least once (and often more than once) in a lifetime, so this is a significant problem.

No one has a perfect answer yet because we still don’t know what treatment works best. Physical therapists have contributed some answers by looking at patients who got well with certain specific treatments. They used this information to start classifying patients by treatment results rather than by diagnoses. Finding groups of patient characteristics that suggest one treatment would be more beneficial than another for each patient is one way to approach the problem.

There are also groups who have published recommendations for treatment based on best-evidence available. These are called Clinical Practice Guidelines (CPGs). For example, right now, the recommended standard-of-care for acute episodes of low back pain is conservative (nonoperative) care. This begins with pain relievers, a day or two of rest, then activity modification while staying as active as possible.

This approach results in improvement within two weeks for the majority of patients. For those who do not respond to this plan, referral to a chiropractor or physical therapist may be advised. If several months of care under the supervision of these individuals does not yield improvements, referral to a specialist may be the next step.

There isn’t a quick and easy answer for patients like yourself who have gone the full route of visits to all of these health care providers. You fall into a category referred to as chronic pain. There are specialty pain clinics set up to help individuals whose bodies have not responded to standard care. Chronic pain is more of a management issue — helping you find ways to increase your activities and function within the confines of your pain (and without increasing your pain).

You may be able to realize a cost savings by consolidating all of your care with a management team. And if you were able to achieve some of your goals, it would be money well-spent.