title: Chronic low back pain in primary care: a prospective study on the management and course.
abstract: BACKGROUND
  There is little evidence about the management and course of chronic low back pain in primary care.
  
  
  OBJECTIVE
  Our aim was to describe the course of chronic low back pain and the performed diagnostic and therapeutic procedures for patients with chronic low back pain in general practice.
  
  
  METHODS
  Twenty-six GPs involved in the Registration Network Family Practices participated in this prospective follow-up study. All patients and GPs were asked to complete questionnaires at baseline and at 4, 8 and 12 months follow-up.
  
  
  RESULTS
  The GPs provided information about diagnostic and therapeutic procedures concerning 524 patients with chronic low back pain. Diagnostic tests other than history-taking and physical examination were not frequently used. Medication, mostly NSAIDs, was the most frequently used type of treatment (21.6%). The most frequent referrals concerned physiotherapy (16.3%) and neurology or neurologic surgery (6.3%). Information about the course of their chronic low back pain was provided by 368 patients participating in our study. The course of chronic low back pain appeared to be quite stable, as there was only a slight improvement in pain intensity and physical functioning over the 12 months of follow-up.
  
  
  CONCLUSIONS
  A variety of options for the treatment and referral of chronic low back pain patients is available for and used by GPs. Efforts should be made to establish which diagnostic and therapeutic procedures are the most effective for chronic low back pain.
authors.affiliation: Institute for Research in Extramural Medicine, Vrije Universiteit, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: van Tulder
authors.forename: B W
authors.initials: BW
authors.lastname: Koes
authors.forename: J F
authors.initials: JF
authors.lastname: Metsemakers
authors.forename: L M
authors.initials: LM
authors.lastname: Bouter
mesh_terms: D000328:Adult; D005194:Family Practice / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data