Managing Low Back Pain-A Comparison of the Beliefs and Behaviors of Family Physicians and Chiropractors

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Managing Low Back Pain-A Comparison of the Beliefs and Behaviors of Family Physicians and Chiropractors
DANIEL C. CHERKIN, PhD; FREDERICK A. MacCORNACK, PhD; and ALFRED 0. BERG, MD, MPH, Seattle
Chiropractica

Random samples of 605 family physicians and 299 chiropractors in Washington were surveyed to determine their beliefs about back pain and how they would respond to three hypothetic patients with back pain. With 79% of the family physicians and 70% of the chiropractors responding, family physicians and chiropractors differed greatly not only in their technical approaches to back pain-such as drug therapy versus spinal manipulation-but also in their underlying beliefs and attitudes. Family physicians think that most back pain is caused by muscle strain, that lumbosacral radiographs are rarely useful, that appropriate therapy does not depend on a precise diagnosis, and that back pain will usually resolve within a few weeks without professional help. Family physicians were more likely than chiropractors to feel frustrated by patients with back pain, less likely to think they can help patients prevent future episodes of back pain, and less confident that their patients are satisfied with their care. Studies are needed to determine whether the different perspectives of family physicians and chiropractors are associated with differences in the costs and outcomes of care.

(Cherkin DC, MacCornack FA, Berg AO: Managing low back pain-A comparison of the beliefs and behaviors of family
physicians and chiropractors. West J Med 1988 Oct; 149:475-480)

Back pain is one of the most common and costly health problems affecting the populations of industrialized nations. Swedish studies suggest that as many as 80% of adults will experience back pain during their lifetimes' and that 40% to 50% of adults experience back pain each year.2 An estimated $5 billion is spent annually in the United States on the diagnosis and treatment of back pain, and an additional $14 billion is consumed in lost productivity, disability payments, and lawsuits.3
According to the 1980 National Medical Care Utilization and Expenditure Study, 40% of Americans with chronic back pain sought care for their back pain during 1980 from doctors of medicine or osteopathy and 30% sought care from chiropractors.4 Because persons receiving back care from chiropractors made more visits than those receiving care from allopathic and osteopathic physicians (means of 8.2 and 2.8 visits, respectively), almost two thirds of all visits for back pain were to chiropractors. Despite the prominent role that chiropractors play in caring for patients with back pain, there is little information in the medical literature about how chiropractors actually manage patients with back pain, the efficacy of chiropractic therapy, or the relative cost-effectiveness of chiropractic care versus allopathic or osteopathic care for this problem.
Because of concerns about the costs and quality of care given patients with back pain, an effort was made to learn how family physicians and chiropractors provide care for patients with back pain and how patients respond to the care they receive from these practitioners. We compare the beliefs and attitudes about back pain of family physicians and chiropractors and their clinical responses to patients with back pain.

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