Physician Office Visits for Low Back Pain: Frequency, Clinical Evaluation, and Treatment Patterns From a U.S. National Survey

Abstract

STUDY DESIGN: This study is an analysis of national survey data from 5 sample years. OBJECTIVES: The authors characterized the frequency of office visits for low back pain, the content of ambulatory care, and how these vary by physician specialty. SUMMARY OF BACKGROUND DATA: Few recent data are available regarding ambulatory care for low back pain or how case mix and patient management vary by physician specialty. METHODS: Data from the National Ambulatory Medical Care Survey were grouped into three time periods (1980-81, 1985, 1989-90). Frequency of visits for low back pain, referral status, tests, and treatments were tabulated by physician specialty. RESULTS: There were almost 15 million office visits for "mechanical" low back pain in 1990, ranking this problem fifth as a reason for all physician visits. Low back pain accounted for 2.8 percent of office visits in all three time periods. Nonspecific diagnostic labels were most common, and 56 percent of visits were to primary care physicians. Specialty variations were observed in caseload, diagnostic mix, and management. CONCLUSIONS: Back pain remains a major reason for all physician office visits. This study describes visit, referral, and management patterns among specialties providing the most care.