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


CONCLUSIONS
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.
Chenot
Jean-François
JF
Dpt. of General Practice, University of Göttingen, Humboldtallee 38, 37073 Göttingen, Germany. jchenot@gwdg.de
Becker
Annette
A
Leonhardt
Corinna
C
Keller
Stefan
S
Donner-Banzhoff
Norbert
N
Baum
Erika
E
Pfingsten
Michael
M
Hildebrandt
Jan
J
Basler
Heinz-Dieter
HD
Kochen
Michael M
MM
D015670:Acupuncture Therapy / Q000379:methods; D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D000529:Complementary Therapies / Q000379:methods*; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods; D008405:Massage / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods*; D011369:Professional-Patient Relations; D011446:Prospective Studies