Low back pain: from algorithm to cost-effectiveness?

Low back pain is one of the most important burdens for the patient, the health-care provider, and society. Treatment selection should target the appropriate use of the available health-care resources with the highest probability of success. When conventional treatment fails to provide satisfactory pain reduction and improvement of the quality of life, more interventional techniques can be envisioned. The degree of invasiveness of the different treatment modalities varies as well as the costs. A stepwise approach to chronic low back pain may reduce the economic burden with optimal use of the less invasive treatments. In this review, we discuss the treatment algorithm with special attention to the interventional pain management techniques. We also describe the results of a cost evaluation for the management of low back pain in Belgium compared with that in the Netherlands, two neighboring countries with different social security systems.