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

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.

Healthcare professionals' sources of knowledge of complementary medicine in an academic center.

BACKGROUND: Complementary medicine (CM) is utilized in a growing number of academic centers despite the debate concerning its value, risks and benefits. Healthcare professionals often feel uncomfortable discussing CM with patients, and little is known about their sources of knowledge in the field of CM. OBJECTIVE: To assess healthcare professionals' sources of knowledge and attitude toward CM in an academic hospital. DESIGN AND PARTICIPANTS: The cross-sectional web-based survey took place from October to December 2013. A total of 4,925 healthcare professionals working at Lausanne University Hospital, Switzerland, were invited to answer the questionnaire. MAIN MEASURES: Factors influencing healthcare professionals' opinion toward CM, knowledge and communication about CM. KEY RESULTS: The questionnaire was answered by 1,247 healthcare professionals. The three key factors influencing professionals' opinion toward CM were personal experience, clinical experience and evidence demonstrating the physiological mechanism of CM. Personal experience was more associated with nurses' and midwives' opinion compared to physicians' (80.8% vs 57.1%, OR = 3.08, [95% CI: 2.35-4.05], P<0.001 and 85.3% vs 57.1%, OR = 3.83, [95% CI: 1.95-7.53], P<0.001, respectively) as well as with professionals trained in CM compared to non-trained professionals (86.0% vs 73.2%, OR = 2.60, [95% CI: 1.92-3.53], P<0.001). Physicians relied more on randomized controlled clinical trials compared to nurses (81.3% vs 62.9%, OR = 0.43, [95% CI: 0.33-0.57], P<0.001). A majority of the respondents (82.5%) agreed that they lacked knowledge about CM and 65.0% noted that it was the patient who initially started the discussion about CM. CONCLUSIONS: Different professionals used different strategies to forge opinions regarding CM: physicians relied more on scientific evidence, while nurses and midwives were more influenced by personal experience. Regardless of preferred information source, most respondents did not feel prepared to address patient questions regarding CM. Enhancing interprofessional education opportunities is an important strategy to help providers become empowered to discuss CM with patients. This in turn will help patients making informed decisions in their healthcare.

[Complementary medicine for low back pain : what is the scientific evidence ?] / Médecines complémentaires et lombalgies : que dit la littérature scientifique ?

Complementary medicines are frequently used by chronic pain patients. It is a challenge for the primary care physician to provide objective information based on the scientific literature. Meta-analyses have shown favourable effects of acupuncture, therapeutic massage and osteopathy for patients with acute low back pain. Concerning chronic low back pain, meta-analyses have shown positive results with acupuncture, osteopathy, yoga and tai-chi. Other therapies have shown positive effects, but further trials are necessary to fully validate them. This article reviews the literature supporting the most studied complementary medicines.

Les patients souffrant de douleurs chroniques sont souvent demandeurs de médecines complémentaires. C'est un défi pour le médecin de famille de les informer de façon objective, en se basant sur les données de la littérature scientifique. Actuellement, des méta-analyses montrent un effet favorable de l'acupuncture, du massage thérapeutique et de l'ostéopathie pour les lombalgies aiguës. Pour ce qui est des lombalgies chroniques, des méta-analyses ont montré un effet bénéfique de l'acupuncture, de l'ostéopathie, du yoga et du tai-chi. D'autres thérapies semblent bénéfiques, mais demandent encore à être validées. Cet article revoit l'évidence soutenant les médecines complémentaires les mieux étudiées.

The Attitudes of Physicians, Nurses, Physical Therapists, and Midwives Toward Complementary Medicine for Chronic Pain: A Survey at an Academic Hospital.

OBJECTIVE: To assess the attitudes of physicians, nurses, physical therapists, and midwives toward complementary medicine (CM) at a Swiss academic hospital and toward its use for treating chronic pain. DESIGN: The cross-sectional survey took place from October to December 2013. SETTING: An e-mail sent to 4925 healthcare professionals (1969 physicians, 2372 nurses, 145 physical therapists, and 111 midwives) working at Lausanne University Hospital, Switzerland, invited them to answer a web-based questionnaire. RESULTS: The questionnaire was answered by 1247 healthcare professionals (response rate: 25.3%). Of these, 96.1% strongly agreed or agreed that CM could be useful for the treatment of chronic pain, with more nurses (96.7%) and midwives (100%) than physicians (93.8%) agreeing that CM could be useful (P < .001 for both comparisons). Women had more positive attitude toward CM than men (97.8% versus 91.2%; P < .001). Of the respondents, 96.9% were strongly in favor or in favor of offering CM, especially hypnosis (89.8%), osteopathy (85.5%), and acupuncture (83.4%), at the hospital for treating chronic pain. Respondents listed migraine (74.7%), tension headaches (70.6%), and low back pain (70.1%) as three main conditions for which they would refer patients for acupuncture. The three therapies with which respondents were the most unfamiliar were neuraltherapy (57.2%), mindfulness-based stress reduction (MBSR) (54.1%), and biofeedback (51.9%). Over half of respondents, 58.3%, had never referred a patient to a CM practitioner. A total of 84.3% of the respondents felt that they lacked the knowledge to inform their patients about CM.