title: Understanding primary care physicians' treatment of chronic low back pain: the role of physician and practice factors.
abstract: BACKGROUND
  An increasing number of Operation Iraqi Freedom/Operation Enduring Freedom veterans experience chronic pain. Despite treatment guidelines, there is wide variation in physicians' approaches to pain treatment, and many physicians are unsure of the best treatment approach. Research has examined factors associated with opioid prescribing, but there is little information on physician characteristics that predict patterns of clinical responses to pain.
  
  
  OBJECTIVE
  To identify patterns in primary care physicians' treatment decisions for nonmalignant chronic pain, and identify physician and practice characteristics that predict treatment decision patterns.
  
  
  METHODS
  A national sample of 381 primary care physicians who responded to a mailed vignette involving a veteran with chronic low back pain (LBP) were categorized into latent classes by clinical actions taken to treat the pain. The associations between newly derived treatment patterns and physician and practice characteristics were examined with multivariate models.
  
  
  RESULTS
  Latent class analysis identified three treatment approaches: 1) Multimodal/Aggressive (14%); 2) Low Action (38%); and 3) Psychosocial/Non-Opioid (48%). In a multivariate model, treatment pattern was associated with demographic and personality factors; opioid-related attitudes, beliefs, and concerns; perceptions of the patient; availability of resources; and practice characteristics.
  
  
  CONCLUSIONS
  There may be distinct patterns in primary care physicians' responses to patients with chronic pain. Relatively few physicians use the multimodal approach endorsed by proponents of the biopsychosocial model of pain treatment. Several physician and practice characteristics predict patterns of clinical action.
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA. phel0085@umn.edu
authors.forename: Sean M
authors.initials: SM
authors.lastname: Phelan
authors.forename: Michelle
authors.initials: M
authors.lastname: van Ryn
authors.forename: Melanie
authors.initials: M
authors.lastname: Wall
authors.forename: Diana
authors.initials: D
authors.lastname: Burgess
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology