title: "You feel so hopeless": a qualitative study of GP management of acute back pain.
abstract: BACKGROUND
  Biopsychosocial management of non-specific back pain in general practice has been problematical, with frequent inappropriate referral for imaging and secondary care interventions and lack of self-confidence in the ability to provide evidence-based care.
  
  
  OBJECTIVE
  To examine GP attitudes to managing back pain as a biopsychosocial problem in order to inform future educational strategies that may improve practice.
  
  
  METHODS
  Twenty-one GPs from separate practices within the Dorset and Somerset Strategic Health Authority area (UK) participated in telephone interviews leading to the development of vignettes to refine the theoretical framework for subsequent focus group interviews about evidence-based back pain management. Transcripts were analysed thematically.
  
  
  RESULTS
  There were 5 main emergent themes. These were generally negative and dominated by concerns about doctor-patient interaction. They included feelings of frustration, mismatches of perceptions in the doctor-patient relationship, problems in relation to time, challenges and discord between stakeholders in the process (for example, over sickness certification) and a lack of resources for education, awareness and local services to refer to. Psychosocial aspects of the actual care process were rarely raised. Participants favoured education that is multidisciplinary, in small group format and involves the participation of patients.
  
  
  CONCLUSIONS
  This study illustrates the difficulties that GPs may have in applying the relevant evidence for the successful management of back pain. A desire to avoid conflict in the relationship with patients explained much of the problem of implementing evidence in general practice. This indicates a need for insightful educational strategies that involve active GP participation.
authors.affiliation: Institute for Musculoskeletal Research and Clinical Implementation, AECC, 13-15 Parkwood Road, Bournemouth, Dorset BH5 2DF, UK. imrci.abreen@aecc.ac.uk
authors.forename: Alan
authors.initials: A
authors.lastname: Breen
authors.forename: Helen
authors.initials: H
authors.lastname: Austin
authors.forename: Charles
authors.initials: C
authors.lastname: Campion-Smith
authors.forename: Eloise
authors.initials: E
authors.lastname: Carr
authors.forename: Eileen
authors.initials: E
authors.lastname: Mann
mesh_terms: D000208:Acute Disease; D001291:Attitude of Health Personnel; D001416:Back Pain / Q000523:psychology* / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000193:education; D005194:Family Practice / Q000193:education / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008960:Models, Psychological; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D011787:Quality of Health Care; D012017:Referral and Consultation; D012657:Self-Help Groups; D006113:United Kingdom