title: Patients' experiences and perceptions of integrative care for back and neck pain.
abstract: BACKGROUND
  Conventional guidelines in Sweden recommend primary care management for back and neck pain, yet these two conditions are the most common ones for which patients use complementary therapies. Despite the recent growth of integrative medicine (IM) in different clinical, academic, and societal contexts, few studies have defined and investigated comprehensive models of integrative care as compared to conventional management, especially using randomized clinical trials.
  
  
  OBJECTIVE
  The study explores patients' experiences and perceptions when receiving conventional or integrative care in the management of back and neck pain.
  
  
  METHODS
  The research team conducted this study within a larger interventional study. In that study--a pragmatic randomized clinical pilot trial--the team developed a model for integrative medicine that combines complementary therapies that have an emerging evidence base and conventional treatments for patients with nonspecific back and neck pain. The research team implemented the model and compared the results for integrative care to results for conventional primary care. The current qualitative study included 11 focus-group discussions: conventional care (n= 5) and integrative care (n=6).
  
  
  METHODS
  The research team implemented the interventional study in south suburban Stockholm, an area with higher unemployment, lower incomes, and receipt of more welfare support and sickness benefits compared to the average levels in Stockholm.
  
  
  METHODS
  The participants in the focus-group discussions were volunteers drawn from the larger randomized clinical trial.
  
  
  METHODS
  The research team transcribed all discussions from the focus groups verbatim and used latent content analysis to evaluate the data.
  
  
  RESULTS
  Receiving diagnostic support and excluding pathology were strong reasons for participants to seek conventional care. Participants reported that they found conventional management to be reductionistic, with a focus on disease, and a lack of accessibility, time, and guidance. In contrast, participants reported that integrative care was holistic, whole-person management and facilitated increased treatment response, support, empowerment, and self-help strategies. Participants, however, perceived integrative care to be challenging because of additional treatment costs with complementary therapies and collaborative shortcomings between integrative and conventional practitioners generally.
  
  
  CONCLUSIONS
  Integrative care represents a combination of valuable conventional medical diagnosis with empowering self-help strategies for some patients with nonspecific back and neck pain in Swedish primary care. Future studies should also investigate experiences and perceptions in the longer term from the perspective of patients, caregivers, and health systems.
authors.affiliation: Research Unit for Sudies of Integrative Health Care, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Huddinge, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Andersson
authors.forename: Susanne
authors.initials: S
authors.lastname: Andersson
authors.forename: T
authors.initials: T
authors.lastname: Sundberg
authors.forename: Tobias
authors.initials: T
authors.lastname: Sundberg
authors.forename: E
authors.initials: E
authors.lastname: Johansson
authors.forename: Eva
authors.initials: E
authors.lastname: Johansson
authors.forename: T
authors.initials: T
authors.lastname: Falkenberg
authors.forename: Torkel
authors.initials: T
authors.lastname: Falkenberg
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000628:therapy*; D000529:Complementary Therapies / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006694:Holistic Health; D006801:Humans; D055048:Integrative Medicine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy*; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D057285:Precision Medicine / Q000379:methods*; D011795:Surveys and Questionnaires; D013548:Sweden; D016896:Treatment Outcome; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult