Patients’ experiences of the management of lower back pain in general practice: use of diagnostic imaging, medication and provision of self-management advice
Mariko Carey A B G , Heidi Turon A B , Stacy Goergen C D , Rob Sanson-Fisher A B , Sze Lin Yoong A F and Kay Jones EA Priority Research Centre for Health Behaviour, Faculty of Health, University of Newcastle, W4 HMRI Building, Callaghan, NSW 2308, Australia.
B Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW 2305, Australia.
C Department of Diagnostic Imaging, Southern Health, 246 Clayton Road, Clayton, Vic. 3168, Australia.
D School of Clinical Sciences at Monash Health, Monash Medical Centre, Block E, Level 5, 246 Clayton Road, Clayton, Vic. 3168, Australia.
E Office of Pro-Vice Chancellor, Monash University, Peninsula Campus, Building D, McMahons Road, Frankston, Vic. 3199, Australia.
F University of Newcastle, c/o Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia.
G Corresponding author. Email: Mariko.Carey@newcastle.edu.au
Australian Journal of Primary Health 21(3) 342-346 https://doi.org/10.1071/PY14057
Submitted: 25 March 2014 Accepted: 16 June 2014 Published: 30 July 2014
Abstract
Lower back pain is prevalent in the general community. Guidelines recommend against the use of diagnostic imaging unless ‘red flags’ are present that may indicate a potentially serious cause. This paper reports on a cross-sectional electronic survey to investigate self-reported experiences of lower back pain management among Australian general practice patients. Of the 872 participants, 551 (63%) reported that they had experienced lower back pain in the past 12 months. Approximately 40% of patients who had experienced lower back pain reported that they had consulted their general practitioner (GP) regarding this issue. Among those who sought general practice care, 67% reported being referred for diagnostic imaging. Those who received imaging were more likely to have been prescribed medication by their GP, but received self-management advice at the same rate as those who had not been referred. Rates of self-reported referral for diagnostic imaging were higher than expected, given the low prevalence of potentially serious causes for lower back pain reported in the international literature. However, it remains unclear whether this is due to poor guideline adherence by GPs or lack of specificity in the red flags identified in guidelines. Findings suggest the need for improvements in the provision of evidence-based self-management advice.
Additional keywords: cross-sectional survey, guideline adherence, patient management, prevalence, primary care.
References
Atlas SJ, Deyo RA (2001) Evaluating and managing acute low back pain in the primary care setting. Journal of General Internal Medicine 16, 120–131.| Evaluating and managing acute low back pain in the primary care setting.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3ksF2qug%3D%3D&md5=5f935c18169987f09d622e50f3f78039CAS | 11251764PubMed |
Australian Acute Musculoskeletal Pain Guidelines Group (2003) Evidence-based management of acute musculoskeletal pain. (Australian Academic Press: Bowen Hills)
Britt H, Miller G, Charles J, Henderson J, Bayram C, Pan Y, Valenti L, Harrison C, O’Halloran J, Fahridin S (2010) General practice activity in Australia 2009–10. (Australian Institute of Health and Welfare: Canberra)
Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine 147, 478–491.
| Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society.Crossref | GoogleScholarGoogle Scholar | 17909209PubMed |
Chou R, Fu R, Carrino JA, Deyo RA (2009) Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet 373, 463–472.
| Imaging strategies for low-back pain: systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 19200918PubMed |
Chou R, Qaseem A, Owens DK, Shekelle P (2011) Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Annals of Internal Medicine 154, 181–189.
| Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians.Crossref | GoogleScholarGoogle Scholar | 21282698PubMed |
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359, 1761–1767.
| Epidemiology and outcomes of osteoporotic fractures.Crossref | GoogleScholarGoogle Scholar | 12049882PubMed |
Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB (2010) Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 6, CD007612
Deyo RA, Rainville J, Kent DL (1992) What can the history and physical examination tell us about low back pain? Journal of the American Medical Association 268, 760–765.
| What can the history and physical examination tell us about low back pain?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK38zkvFGluw%3D%3D&md5=cd4b216ec537d2efd1f1c461cfa10180CAS | 1386391PubMed |
Deyo RA, Mirza SK, Martin BI (2006) Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine 31, 2724–2727.
| Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002.Crossref | GoogleScholarGoogle Scholar | 17077742PubMed |
Di Iorio D, Henley E, Doughty A (2000) A survey of primary care physician practice patterns and adherence to acute low back problem guidelines. Archives of Family Medicine 9, 1015–1021.
| A survey of primary care physician practice patterns and adherence to acute low back problem guidelines.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FoslSqtw%3D%3D&md5=c4f1fe42a7c1ef43a2a0a8db9095b924CAS | 11115201PubMed |
French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ (2006) Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 1, CD004750
Furlan AD, Imamura M, Dryden T, Irvin E (2008) Massage for low-back pain. Cochrane Database of Systematic Reviews 4, CD001929
Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley J (2009) Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis and Rheumatism 60, 3072–3080.
| Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain.Crossref | GoogleScholarGoogle Scholar | 19790051PubMed |
Ivanova JI, Birnbaum HG, Schiller M, Kantor E, Johnstone BM, Swindle RW (2011) Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care. The Spine Journal 11, 622–632.
| Real-world practice patterns, health-care utilization, and costs in patients with low back pain: the long road to guideline-concordant care.Crossref | GoogleScholarGoogle Scholar | 21601533PubMed |
Kendrick D, Fielding K, Bentley E, Kerslake R, Miller P, Pringle M (2001) Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ (Clinical Research Edition) 322, 400–405.
| Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7lvVeiug%3D%3D&md5=e47d385569938ea40b7b39c66adc21a5CAS |
Macfarlane GJ, Beasley M, Jones EA, Prescott GJ, Docking R, Keeley P, McBeth J, Jones GT (2012) The prevalence and management of low back pain across adulthood: results from a population-based cross-sectional study (the MUSICIAN study). Pain 153, 27–32.
| The prevalence and management of low back pain across adulthood: results from a population-based cross-sectional study (the MUSICIAN study).Crossref | GoogleScholarGoogle Scholar | 21978663PubMed |
Paul CL, Carey M, Yoong SL, D’Este C, Makeham M, Henskens F (2013) Access to chronic disease care in general practice: the acceptability of implementing systematic waiting-room screening using computer-based patient-reported risk status. The British Journal of General Practice 63, e620–e626.
| Access to chronic disease care in general practice: the acceptability of implementing systematic waiting-room screening using computer-based patient-reported risk status.Crossref | GoogleScholarGoogle Scholar | 23998842PubMed |
Reijneveld SA, Stronks K (2001) The validity of self-reported use of health care across socioeconomic strata: a comparison of survey and registration data. International Journal of Epidemiology 30, 1407–1414.
| The validity of self-reported use of health care across socioeconomic strata: a comparison of survey and registration data.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2Fpt1antg%3D%3D&md5=e7103bd6be8df7e292b873e94b030d50CAS | 11821355PubMed |
Walker BF, Muller R, Grant WD (2004) Low back pain in Australian adults. Prevalence and associated disability. Journal of Manipulative and Physiological Therapeutics 27, 238–244.
| Low back pain in Australian adults. Prevalence and associated disability.Crossref | GoogleScholarGoogle Scholar | 15148462PubMed |
Williams CM, Maher CG, Hancock MJ, McAuley JH, McLachlan AJ, Britt H, Fahridin S, Harrison C, Latimer J (2010) Low back pain and best practice care: a survey of general practice physicians. Archives of Internal Medicine 170, 271–277.
| Low back pain and best practice care: a survey of general practice physicians.Crossref | GoogleScholarGoogle Scholar | 20142573PubMed |
Yoong SL, Carey ML, Sanson-Fisher RW, Russell G, Mazza D, Makeham M, Paul CL, Inder KJ, D’Este C (2012) Touch screen computer health assessment in Australian general practice patients: a cross-sectional study protocol. BMJ Open 2, e001405
| Touch screen computer health assessment in Australian general practice patients: a cross-sectional study protocol.Crossref | GoogleScholarGoogle Scholar | 22761290PubMed |
