Primary care physicians' attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study

Abstract

Objective: Recent guidelines for chronic or recurrent low back pain recommend non-pharmacologic treatments as first-line options. The objective of this study was thus to explore the perceived usefulness of several conventional and complementary medicine treatments for chronic or recurrent low back pain by primary care physicians and their reported prescribing behavior.

Design: An exploratory cross-sectional study.

Setting and participants: Primary care physicians of the French-speaking part of Switzerland.

Main outcome measures: Primary care physicians' perceived usefulness of each conventional and complementary medicine treatment and their reported recommendation behavior were considered dependent variables in multivariate logistic regression models. All correlations were computed between binary variables, and phi coefficients were calculated to estimate correlation strengths.

Results: 533 primary care physicians answered the questionnaire (response rate: 25.6%). The top 3 conventional treatments most often considered useful by primary care physicians for chronic or recurrent low back pain were physiotherapy (94.8%), nonsteroidal anti-inflammatory drugs (87.9%), and manual therapy (82.5%), whereas the most prescribed conventional treatments were physiotherapy (99.2%), nonsteroidal anti-inflammatory drugs (97.4%), and acetaminophen (94.4%). Osteopathic treatment (78.4%), yoga (69.3%), and therapeutic massage (63.9%) were the complementary medicine treatments most often considered useful by primary care physicians in managing chronic or recurrent low back pain. Being a female physician, younger than 56 years, trained in complementary medicine, or using complementary medicine were all associated with higher perceived usefulness of complementary medicine treatments in general. The most recommended complementary medicine treatments by primary care physicians were osteopathic treatment (87.3%), acupuncture (69.3%), and therapeutic massage (58.7%). Being a female physician, younger than 56, and using complementary medicine were all associated with more complementary medicine recommendation in general.

Conclusion: Our results highlight the importance of better understanding the prescribing patterns of primary care physicians for chronic or recurrent low back pain. Considering the frequency and burden of chronic or recurrent low back pain, programs focusing on the most (cost-) effective treatments should be implemented.

Fig 1. Diagram of study participation.

PCPs = primary care physicians.

Fig 2. Perceived usefulness of chronic or recurrent LBP treatments among PCPs compared with reported prescribing/recommendation behavior.

For each treatment, the proportion of PCPs who agree with its usefulness (dark gray) or have already prescribed or recommended it (gray) is shown. Error bars express 95% confidence interval. chronic or recurrent LBP = chronic or recurrent low back pain; PCPs = primary care physicians; NSAIDs = nonsteroidal anti-inflammatory drugs. *Complementary medicine.