The epidemiology and medical management of low back pain during ambulatory medical care visits in the United StatesReport as inadecuate




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Osteopathic Medicine and Primary Care

, 2:11

First Online: 24 November 2008Received: 10 August 2008Accepted: 24 November 2008

Abstract

BackgroundLow back pain LBP is a common symptom.

MethodsPatient visits attributed to LBP in the National Ambulatory Medical Care Survey NAMCS during 2003–2004 served as the basis for epidemiological analyses n = 1539. The subset of patient visits in which LBP was the primary reason for seeking care primary LBP patient visits served as the basis for medical management analyses n = 1042. National population estimates were derived using statistical weighting techniques.

ResultsThere were 61.7 million SE, 4.0 million LBP patient visits and 42.4 million SE, 3.1 million primary LBP patient visits. Only 55% of LBP patient visits were provided by primary care physicians. Age, geographic region, chronicity of symptoms, injury, type of physician provider, and physician specialty were associated with LBP patient visits. Age, injury, primary care physician status, type of physician provider, and shared physician care were associated with chronicity of LBP care. Osteopathic physicians were more likely than allopathic physicians to provide medical care during LBP patient visits odds ratio OR, 2.61; 95% confidence interval CI, 1.75–3.92 and chronic LBP patient visits OR, 4.39; 95% CI, 2.47–7.80. Nonsteroidal anti-inflammatory drugs NSAIDs and narcotic analgesics were ordered during 14.2 million SE, 1.2 million and 10.5 million SE, 1.1 million primary LBP patient visits, respectively. Drugs OR, 0.29; 95% CI, 0.13–0.62 and, specifically, NSAIDs OR, 0.40; 95% CI, 0.25–0.64 were ordered less often during chronic LBP patient visits compared with acute LBP patient visits. Overall, osteopathic physicians were less likely than allopathic physicians to order NSAIDs for LBP OR, 0.43; 95% CI, 0.24–0.76. Almost two million surgical procedures were ordered, scheduled, or performed during primary LBP patient visits.

ConclusionThe percentage of LBP visits provided by primary care physicians in the United States remains suboptimal. Medical management of LBP, particularly chronic LBP, appears to over-utilize surgery relative to more conservative measures such as patient counseling, non-narcotic analgesics, and other drug therapies. Osteopathic physicians are more likely to provide LBP care, and less likely to use NSAIDs during such visits, than their allopathic counterparts. In general, LBP medical management does not appear to be in accord with evidence-based guidelines.

Electronic supplementary materialThe online version of this article doi:10.1186-1750-4732-2-11 contains supplementary material, which is available to authorized users.

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Author: John C Licciardone

Source: https://link.springer.com/



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