Misbeliefs about non-specific low back pain and attitudes towards treatment by primary care providers in Spain: a qualitative study

Abstract

Aim To identify misbeliefs about the origin and meaning of non-specific chronic low back pain and to examine attitudes towards treatment by primary health care providers. Design Generic qualitative study. Methods Ten semi-structured interviews were conducted between October and November 2016 with physicians and nurses from primary health care centres in Lleida. The interviews were transcribed and analysed using inductive thematic analysis via Atlas.ti-8 software. Results Five themes were identified: i. beliefs about the origin and meaning of chronic low back pain, ii. psychosocial aspects of pain modulators, iii. Therapeutic exercise as a treatment for chronic low back pain, iv. biomedical attitudes of primary health care providers, and v. difficulties in the clinical approach to chronic low back pain. Conclusion Primary health care providers have a unifactorial view of chronic low back pain and base their approach on the biomedical model. Professionals attribute chronic low back pain to structural alterations in the lumbar spine while psychosocial factors are only recognized as pain modulators. For professionals, therapeutic exercise represents a possible solution to chronic low back pain; however, they still do not prescribe it and continue to educate on postural hygiene and recommend limiting physical and/or occupational activities, as opposed to clinical practice guidelines. These findings suggest that to improve the adherence of primary health care providers to the biopsychosocial model, it may be necessary first to modify their misbeliefs about non-specific chronic low back pain by increasing their knowledge on pain neurophysiology. Trial registration ClinicalTrials.gov Identifier: NCT02962817. Date of registration: 11/11/2016.

Physiotherapists' Pain Beliefs and Treatment Selection for Low Back Pain: A Cross-sectional Study

“…The findings of this study align closely with previous research conducted in various countries, including the UK, Canada, and New Zealand. In those studies, the mean scores for the biomedical and bio-psychosocial subscales were consistently reflected at 30.7 and 43.4, respectively, showcasing a level of consistency across different geographical contexts [9,[20][21][22]. However, other studies reported slightly different findings, with some studies reporting a higher score for the bio-psychosocial subscale and a lower score for the biomedical subscale.…”

“…Previous studies reported that the treatment selection for CLBP is not solely influenced by physiotherapists' fear-avoidance beliefs but is instead influenced by various factors, such as their understanding of pain, education, and other individual and environmental factors [19,20]. Accordingly, this study discerns the beliefs and attitudes of Indian physiotherapists regarding the choice of treatments for low back pain and its correlation with the selected models of pain.…”

Medical and exercise consultation use for low back and knee pain among cardiovascular mass screening population: A cross-sectional study

“…Instructed therapeutic exercise could be one of the first-line options for treatment of chronic musculoskeletal pain ( Babatunde et al, 2017 ). A previous qualitative study of primary care physicians and nurses and revealed that they believe therapeutic exercise can be beneficial in the treatment of chronic low back pain but do not necessarily prescribe it, rather tending to limit physical exercise and work activity in patients ( García-Martínez et al, 2022 ). This could be due to fear-avoidance beliefs of the medical professional themselves ( Darlow et al, 2012 ).…”

Biomedical Dogmas Still Influence the Delivery of Exercise Therapy in Chronic Low Back Pain Management: Mixed-Methods Study

“… 32 Another example of practitioner-related misbeliefs about NSCLBP management can be illustrated by an investigation conducted with general practitioners in Spain. 33 The authors of this qualitative study identified that interviewed general practitioners considered therapeutic exercise as a suitable approach to NSCLBP management but hesitated to prescribe it and continued to educate patients about postural hygiene or recommended limiting activities contrary to recommendations of international practice guidelines. 33 …”