News release

From: The University of Sydney

Among the myriad medical treatments for low back pain – a leading cause of disability that affects more than 600 million people worldwide – new Australian research has found that simpler and relatively more affordable lifestyle solutions may make the biggest difference.

The study revealed that quitting smoking, exercising more, improving sleep, and maintaining a healthy body weight were all linked to lower overall healthcare costs and reduced reliance on medication for back pain.

The researchers were surprised to find that women paid some of the highest costs associated with low back pain – 76 percent more than men.

“When it comes to low back pain, many people think they need to make a dramatic change, then throw it in the ‘too-hard basket’ and just pop a pill, which often doesn’t help,” said senior author Professor Paulo Ferreira from the Charles Perkins Centre and the School of Health Sciences in the Faculty of Medicine and Health. “But our study shows you only need to make small, achievable changes to reap real benefits.”

Professor Ferreira said his team’s mission is to uncover simple, affordable, evidence-based solutions that can be easily implemented in everyday life.

The study, which followed participants over 12 months, assessed a range of lifestyle factors including body mass index (BMI), physical activity levels, smoking status, and sleep quality, to investigate their relationship to healthcare cost savings.

Using a scale ranging between 0-8, researchers assigned each of the four personal behaviours a score of 0-2. They found that for every one-point improvement in a behaviour, participants spent 23 percent less on back pain treatments.

Better sleep was strongly associated with significant savings – up to $1000 less in out-of-pocket healthcare expenses per year, including fewer GP, physiotherapy and chiropractic visits and less money spent on medication.

“We saw a clear, linear relationship between healthier lifestyle habits and lower medication use,” Professor Ferreira said. “Previous studies have shown that analgesic medicines, including opioids, don’t help much and shouldn’t be used long-term. We should be supporting people to manage their pain through sustainable, simple and achievable healthy lifestyle changes.”

PhD researcher Tiara Tian, lead author on the study, said even small improvements can make measurable differences.

“If someone currently does 60 minutes of moderate activity (like brisk walking or cycling) a week and increases that to 75 minutes, that’s considered a one-point improvement, and they’ll spend 23 percent less on out-of-pocket treatments,” she said. “Not meeting the WHO’s activity guideline of less than 60 minutes per week is considered ‘poor’ on the lifestyle scale, while 60–150 minutes is an ‘intermediate’ level.”

When it comes to sleep, Ms Tian said quality matters just as much as quantity.

“Good sleep means less waking up overnight and better rest overall. Reducing cognitive arousal (for example worries about back pain during the night) before bed is key: things like dimming the lights, avoiding screens, listening to calm music, meditating, or stretching can all help create a nightly routine focused on wellbeing.”

Smoking status was another important factor. Current smokers were given a “poor” score, former smokers “intermediate,” and non-smokers the highest score. While former smokers couldn’t improve their score further, quitting still delivered long-term health benefits.

“Smoking has a systemic impact, meaning there’s no part of the body it doesn’t affect,” Professor Ferreira said. “It impairs circulation in the spine and surrounding tissues, which can contribute to ongoing back issues.”

Addressing why so many women pay high costs for back pain treatment he said:

“This is likely because women have a higher rate of low back pain, often take on family caregiver roles, and are more proactive about seeking medical care.”

Experts say back pain management must move away from a one-size-fits all approach and focus on gender-specific, tailored care. This includes better communication between low back pain survivors and healthcare providers around cost-effective options – such as simple, achievable lifestyle changes – to help prevent repeated, costly flare-ups.