Patient-Reported Physician Treatment Recommendations and Compliance Among U.S. Adults with Low Back Pain

Abstract

Objectives: Numerous recently published clinical care guidelines, including the 2017 American College of Physicians (ACP) Guideline for Low Back Pain (LBP), call for nonpharmacological approaches to pain management. However, little data exist regarding the extent to which these guidelines have been adopted by patients and medical doctors. The study objective was to determine patient-reported treatment recommendations by medical doctors for LBP and patient compliance with those recommendations.Design: This study used a cross-sectional web and mail survey.Settings/Location: The study was conducted among Gallup Panel members across the United States. Subjects: Survey participants included 5377 U.S. adults randomly selected among Gallup Panel members. Of those, 545 reported a visit to a medical doctor within the past year for low back pain and were asked a series of follow-up questions regarding treatment recommendations.Interventions: Participants were asked about medical doctor recommendations for both drug (acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs], opioids, benzodiazepines, Gabapentin, Neurontin, and cortisone injections) and nondrug (self-care treatments, massage, acupuncture, spinal manipulation, and physical therapy) treatments.Outcome Measures: Participants were asked to indicate if their medical doctor recommended each drug and nondrug therapy for their LBP and if they had followed each of those treatment recommendations.Results: Ninety-six percent of patients who visited a medical doctor for LBP received a recommendation for one or more pain treatments, with 81% reporting that their medical doctor recommended both drug and nondrug therapies. Seventy-six percent of respondents were recommended acetaminophen or NSAIDs, 79% were recommended self-care treatments, 37% were recommended massage, acupuncture, or spinal manipulation, and 60% were recommended physical therapy. Nearly two-thirds of our sample reported that their doctor had recommended prescription medications, including opioids, benzodiazepines, Gabapentin, Neurontin, or cortisone injections. Reported adherence to treatment recommendations ranged from 68% for acupuncture to 94% for NSAIDs.Conclusions: One year after publication of the ACP's Guideline on LBP, patients report that medical doctors recommended both pharmacological and nonpharmacological treatment approaches to patients with LBP. In the majority of cases, a combination of prescription medications and self-care were recommended, illustrating the need for additional research on the effectiveness of multi-modal treatment strategies. Patients reported that they were largely compliant with medical doctor recommendations, underscoring the influence that medical doctors have in directing patient care for LBP. These findings indicate that further work is also needed to explore the impact of

Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA

“…4 In a 2018 survey, 27.0% of LBP patients reported being recommended BZDs by a medical doctor in the previous 12 months. 26 As adjuvant analgesics, 22 27 BZDs have been used to treat LBP-related muscle spasms 23 28 and neuropathic pain. 24 28 Although early research suggested BZDs had a direct analgesic effect related to central or peripheral receptormediated interactions, 24 29 there has not been conclusive evidence that BZDs produce an overall analgesic effect.…”

Systematic review of guideline-recommended medications prescribed for treatment of low back pain

“…Low back pain is often managed by primary care providers with medication recommendations to include non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids [6][7][8]. Primary care providers, in concordance with clinical practice guidelines (CPG), also encourage non-pharmacological LBP care to include patient education, remaining physical active, and manual therapies.…”

(C)onsumer focused (E)ducation on p(A)racetamol (S)ide (E)ffects, i(N)adequate (O)utcomes and (W)eaning (CEASE NOW) for individuals with low back pain: results of a feasibility study

“…1 2 However, paracetamol remains one of the most commonly used analgesics to manage LBP worldwide, with between 50% and 95% of LBP sufferers across Australia, USA and Europe taking paracetamol. [3][4][5][6][7][8][9] In Australia, this represents a heavy economic burden on individuals and society, as approximately $1 billion dollars per annum spent on LBP treatment is associated with analgesics such as paracetamol. 10 Previous studies have highlighted that consumers lack knowledge and understanding regarding the possible harms when taking paracetamol, with up to…”

“…Currently, many international clinical guidelines in the USA, UK, Germany, Denmark and Belgium no longer recommend the use of paracetamol (acetaminophen) for individuals with low back pain (LBP) due to the lack of clinical benefits and emerging links with adverse events associated with the medication 1 2. However, paracetamol remains one of the most commonly used analgesics to manage LBP worldwide, with between 50% and 95% of LBP sufferers across Australia, USA and Europe taking paracetamol 3–9. In Australia, this represents a heavy economic burden on individuals and society, as approximately $1 billion dollars per annum spent on LBP treatment is associated with analgesics such as paracetamol 10.…”