Date Published: September 27, 2018
Publisher: Public Library of Science
Author(s): Pierre-Yves Rodondi, Julie Dubois, Anne-Sylvie Bill, Daria Koutaïssoff, Jenny Ros, Eléonore Aveni, Jérôme Pasquier, Lilli Herzig, Isabelle Decosterd, Bernard Burnand, Gustavo de Carvalho Machado.
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.
An exploratory cross-sectional study.
Primary care physicians of the French-speaking part of Switzerland.
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.
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.
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.
Chronic low back pain is a common condition, with a global prevalence situated around 20% . Furthermore, recurrent low back pain is also common, with 33% recurrence within the first year following an acute episode of low back pain (LBP) . Conventional treatment options for chronic or recurrent LBP include drug therapies, nonmedical interventions, and surgery . According to a recent systematic review and meta-analysis including 35 randomized placebo-controlled trials, non-steroidal anti-inflammatory drugs (NSAIDs) reduced pain and disability in the immediate and short-term, but did not have clinically important effects on pain intensity . Regarding opioids, another systematic review and meta-analysis showed a short-term effect on pain, but the effect was small and probably not clinically relevant . When it comes to non-pharmacologic interventions, exercise therapy reduced pain intensity and disability better than usual care and behavioral therapies had an effect on pain intensity . Additionally, current scientific data available about complementary medicine (CM) is increasing. The World Health Organization (WHO) defines CM as “a broad set of health care practices that are not part of that country’s own tradition or conventional medicine and are not fully integrated into the dominant health-care system”. Some studies suggest that CM non-pharmacologic therapies such as acupuncture [7–9], yoga [10, 11], Tai-Chi , Mindfulness-based stress reduction , osteopathy  and hypnosis  might be useful treatment options for patients suffering from chronic LBP , although more studies are needed.
This study showed that the top three conventional treatments most often considered useful in the management of chronic or recurrent LBP were physiotherapy, NSAIDs, and manual therapy, whereas the most prescribed conventional treatments were physiotherapy, NSAIDs, and acetaminophen. Osteopathic treatment, yoga, and therapeutic massage were the most often considered useful CMs in the management of chronic or recurrent LBP. The most recommended CM treatments were osteopathic treatment, acupuncture, and therapeutic massage.
Non-pharmacologic treatments for the management of chronic or recurrent LBP, including CM, seem to be underprescribed in comparison with pharmacological treatments. Considering the frequency and burden of chronic or recurrent LBP, the most (cost-) effective treatments should be proposed to patients. Implementation programs targeting PCPs should be used, as well as better access to and reimbursement for effective non-pharmacologic treatments. Repeating the study in a near future would permit to see if the recommendation of the recent guidelines will be followed by PCPs.