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Cited by 126Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyOpioid Use Disorder Treatment

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The epidemiology and medical management of low back pain during ambulatory medical care visits in the United States

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Licciardone, John C·2008·Osteopathic Medicine and Primary Care
DOI 10.1186/1750-4732-2-11PMC PMC2631527
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Abstract

BACKGROUND: Low back pain (LBP) is a common symptom. METHODS: Patient visits attributed to LBP in the National Ambulatory Medical Care Survey (NAMCS) during 2003-2004 served as the basis for epidemiological analyses (n = 1539). The subset of patient visits in which LBP was the primary reason for seeking care (primary LBP patient visits) served as the basis for medical management analyses (n = 1042). National population estimates were derived using statistical weighting techniques. RESULTS: There were 61.7 million (SE, 4.0 million) LBP patient visits and 42.4 million (SE, 3.1 million) primary LBP patient visits. Only 55% of LBP patient visits were provided by primary care physicians. Age, geographic region, chronicity of symptoms, injury, type of physician provider, and physician specialty were associated with LBP patient visits. Age, injury, primary care physician status, type of physician provider, and shared physician care were associated with chronicity of LBP care. Osteopathic physicians were more likely than allopathic physicians to provide medical care during LBP patient visits (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.75-3.92) and chronic LBP patient visits (OR, 4.39; 95% CI, 2.47-7.80). Nonsteroidal anti-inflammatory drugs (NSAIDs) and narcotic analgesics were ordered during 14.2 million (SE, 1.2 million) and 10.5 million (SE, 1.1 million) primary LBP patient visits, respectively. Drugs (OR, 0.29; 95% CI, 0.13-0.62) and, specifically, NSAIDs (OR, 0.40; 95% CI, 0.25-0.64) were ordered less often during chronic LBP patient visits compared with acute LBP patient visits. Overall, osteopathic physicians were less likely than allopathic physicians to order NSAIDs for LBP (OR, 0.43; 95% CI, 0.24-0.76). Almost two million surgical procedures were ordered, scheduled, or performed during primary LBP patient visits. CONCLUSION: The percentage of LBP visits provided by primary care physicians in the United States remains suboptimal. Medical management of LBP, particularly chronic LBP, appears to over-utilize surgery relative to more conservative measures such as patient counseling, non-narcotic analgesics, and other drug therapies. Osteopathic physicians are more likely to provide LBP care, and less likely to use NSAIDs during such visits, than their allopathic counterparts. In general, LBP medical management does not appear to be in accord with evidence-based guidelines.

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Figures

Figure 1 National population estimates of patient visits for low back pain in the United States, 2003–2004. LBP indicates low back pain; NPE, national population estimate; SE, standard error. National population estimates are for both years combined and were computed by applying patient visits weights to the numbers reported in the National Ambulatory Medical Care Survey. Patient visits involving back symptoms attributed to a lump, mass, or tumor are not included as LBP visits. Patient visits other than initial visits for acute problems or follow-up visits for chronic problems are not represented under the "all LBP visits" and "primary LBP visits" headings.
Figure 1 National population estimates of patient visits for low back pain in the United States, 2003–2004. LBP indicates low back pain; NPE, national population estimate; SE, standard error. National population estimates are for both years combined and were computed by applying patient visits weights to the numbers reported in the National Ambulatory Medical Care Survey. Patient visits involving back symptoms attributed to a lump, mass, or tumor are not included as LBP visits. Patient visits other than initial visits for acute problems or follow-up visits for chronic problems are not represented under the "all LBP visits" and "primary LBP visits" headings.CC BY · PubMed Central
Figure 2 Diagnostic tests in the medical management of primary low back pain in the United States, 2003–2004. Other imaging tests are exclusive of mammograms.
Figure 2 Diagnostic tests in the medical management of primary low back pain in the United States, 2003–2004. Other imaging tests are exclusive of mammograms.CC BY · PubMed Central
Figure 3 Patient counseling in the medical management of primary low back pain in the United States, 2003–2004. Mental health counseling also includes stress management and psychotherapy.
Figure 3 Patient counseling in the medical management of primary low back pain in the United States, 2003–2004. Mental health counseling also includes stress management and psychotherapy.CC BY · PubMed Central
Figure 4 Drugs ordered in the medical management of primary low back pain in the United States, 2003–2004. NSAID indicates nonsteroidal anti-inflammatory drug.
Figure 4 Drugs ordered in the medical management of primary low back pain in the United States, 2003–2004. NSAID indicates nonsteroidal anti-inflammatory drug.CC BY · PubMed Central

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Research works printed but not linked: 3

  1. Tenney JB White KL Williamson JW National Ambulatory Medical Care Survey: Background and Methodology Vital and Health Statistics Series 2, No 61 1974 U.S. Department of Health and Human Services. Hyattsville, MD: National Center for Health Statistics 25102417
  2. Food and Drug Administration National Drug Code Directory, 1995 Edition 1995 Washington, D.C.: Public Health Service
  3. Siller AB Tompkins L The big four: analyzing complex sample survey data using SAS®, SPSS®, STATA®, and SUDAAN® (Paper 172-31) Proceedings of the Thirty-first Annual SAS® Users Group International Conference: 2006; Cary, NC 2006 SAS Institute Inc

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Metadata

Authors
Licciardone, J. C.
Affiliations
University of North Texas Health Science Center (US)
Corresponding author
Licciardone, John C
ORCID
Licciardone, John C
Venue
Osteopathic Medicine and Primary Care
Publisher
Springer Science and Business Media LLC
Published
2008
Volume
2
Issue
1
Pages
11
ISSN
1750-4732 (ISSN-L)
DOI
10.1186/1750-4732-2-11
PMC
PMC2631527
OpenAlex
W2033305798
Cited by
126
References
33
Citations by year
2026: 1 · 2025: 9 · 2024: 10 · 2023: 8 · 2022: 16 · 2021: 7 · 2020: 3 · 2019: 6 · 2018: 5 · 2017: 6 · 2016: 6 · 2015: 8 · 2014: 9 · 2013: 9 · 2012: 7
FWCI
3.75
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Osteopathic Medicine and Primary Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Osteopathic Heritage Foundation
  • National Institutes of Health
  • National Center for Complementary and Alternative Medicine
  • National Center for Complementary and Integrative Health (K24AT002422)
Topics
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
low back pain, outpatient visits, primary care physicians, osteopathic physicians, chronic low back pain, acute low back pain, nonsteroidal anti-inflammatory drugs, opioid analgesics, surgical procedures, physician specialty, National Ambulatory Medical Care Survey, health care utilization, drug prescribing, regional variation in care, shared decision-making

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