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      Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

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          Abstract

          Background

          Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain.

          Methods

          This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months

          Results

          A total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM.

          Conclusion

          The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.

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          Most cited references34

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          Unconventional medicine in the United States. Prevalence, costs, and patterns of use.

          D M Eisenberg, R C Kessler, C. Foster … (1993)
          Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. We conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic. We limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. We completed telephone interviews with 1539 adults (response rate, 67 percent) in a national sample of adults 18 years of age or older in 1990. We asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy. One in three respondents (34 percent) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy. The latter group had made an average of 19 visits to such providers during the preceding year, with an average charge per visit of $27.60. The frequency of use of unconventional therapy varied somewhat among socio-demographic groups, with the highest use reported by nonblack persons from 25 to 49 years of age who had relatively more education and higher incomes. The majority used unconventional therapy for chronic, as opposed to life-threatening, medical conditions. Among those who used unconventional therapy for serious medical conditions, the vast majority (83 percent) also sought treatment for the same condition from a medical doctor; however, 72 percent of the respondents who used unconventional therapy did not inform their medical doctor that they had done so. Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million). Expenditures associated with use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. This figure is comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the United States. The frequency of use of unconventional therapy in the United States is far higher than previously reported. Medical doctors should ask about their patients' use of unconventional therapy whenever they obtain a medical history.
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            The continuing use of complementary and alternative medicine in South Australia: costs and beliefs in 2004.

            Paul A. MacLennan, Stuart Taylor, Michael Myers (2006)
            To survey the use, cost, beliefs and quality of life of users of complementary and alternative medicine (CAM). A representative population survey conducted in 2004 with longitudinal comparison to similar 1993 and 2000 surveys. 3015 South Australian respondents over the age of 15 years (71.7% participation). In 2004, CAMs were used by 52.2% of the population. Greatest use was in women aged 25-34 years, with higher income and education levels. CAM therapists had been visited by 26.5% of the population. In those with children, 29.9% administered CAMs to them and 17.5% of the children had visited CAM therapists. The total extrapolated cost in Australia of CAMs and CAM therapists in 2004 was AUD$1.8 billion, which was a decrease from AUD$2.3 billion in 2000. CAMs were used mostly to maintain general health. The users of CAM had lower quality-of-life scores than non-users. Among CAM users, 49.7% used conventional medicines on the same day and 57.2% did not report the use of CAMs to their doctor. About half of the respondents assumed that CAMs were independently tested by a government agency; of these, 74.8% believed they were tested for quality and safety, 21.8% for what they claimed, and 17.9% for efficacy. Australians continue to use high levels of CAMs and CAM therapists. The public is often unaware that CAMs are not tested by the Therapeutic Goods Administration for efficacy or safety.
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              Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain.

              Karen Thorpe, Anthony Roman, Helen E. Campbell … (2006)
              To determine whether a short course of traditional acupuncture improves longer term outcomes for patients with persistent non-specific low back pain in primary care. Pragmatic, open, randomised controlled trial. Three private acupuncture clinics and 18 general practices in York, England. 241 adults aged 18-65 with non-specific low back pain of 4-52 weeks' duration. 10 individualised acupuncture treatments from one of six qualified acupuncturists (160 patients) or usual care only (81 patients). The primary outcome was SF-36 bodily pain, measured at 12 and 24 months. Other outcomes included reported use of analgesics, scores on the Oswestry pain disability index, safety, and patient satisfaction. 39 general practitioners referred 289 patients of whom 241 were randomised. At 12 months average SF-36 pain scores increased by 33.2 to 64.0 in the acupuncture group and by 27.9 to 58.3 in the control group. Adjusting for baseline score and for any clustering by acupuncturist, the estimated intervention effect was 5.6 points (95% confidence interval -0.2 to 11.4) at 12 months (n = 213) and 8.0 points (2.8 to 13.2) at 24 months (n = 182). The magnitude of the difference between the groups was about 10%-15% of the final pain score in the control group. Functional disability was not improved. No serious or life threatening events were reported. Weak evidence was found of an effect of acupuncture on persistent non-specific low back pain at 12 months, but stronger evidence of a small benefit at 24 months. Referral to a qualified traditional acupuncturist for a short course of treatment seems safe and acceptable to patients with low back pain. ISRCTN80764175 [controlled-trials.com].
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMC Complement Altern Med
                Title: BMC Complementary and Alternative Medicine
                Publisher: BioMed Central
                ISSN (Electronic): 1472-6882
                Publication date Collection: 2007
                Publication date (Electronic): 18 December 2007
                Volume: 7
                Page: 42
                Affiliations
                [1 ]Dpt. of General Practice, University of Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
                [2 ]Dpt. of General Practice, Preventive and Rehabilitation Medicine, University of Marburg, Robert-Koch-Str. 5, 35033 Marburg, Germany
                [3 ]Institute for Medical Psychology, University of Marburg, Bunsenstr. 3, 35037 Marburg, Germany
                [4 ]Dpt. of Public Health Sciences, University of Hawaii at Manoa, 1960 East-West Rd., Honolulu, HI 96822, USA
                [5 ]Dpt. of Anaesthesiology, Pain Clinic, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
                Article
                Publisher ID: 1472-6882-7-42
                DOI: 10.1186/1472-6882-7-42
                PMC ID: 2222227
                PubMed ID: 18088435
                SO-VID: ebfefac3-73e5-422f-9827-68b57b7a62e4
                Copyright © Copyright © 2007 Chenot et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 April 2007
                Date accepted : 18 December 2007
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Complementary & Alternative medicine
                Data availability:
                ScienceOpen disciplines: Complementary & Alternative medicine

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