Background/Purpose: Low back pain (LBP) constitutes an important cause of disability and morbidity in general population. Appropriate care for LBP includes non-pharmacological interventions based on a biopsychosocial framework of patient education and advice. World Health Organization recommends that excessively medical solutions should be avoided. This study aimed to estimate prevalence of medical care seeking and characterize diagnostic workup and management procedures for LBP in the adult Portuguese population. We also aim to compare the medical framework for LBP diagnostic and management between primary and secondary care.

Methods: The present study was conducted under the scope of EpiReumaPt (2011-2013), a population-based study including a representative sample of non-institutionalized Portuguese adults (n=10,661 habitants). A sample of individuals who self-reported history of medical care seeking for LBP within the previous 12 months (n=2,618) were considered. Patients’ self-reported data collected through a structured questionnaire was explored to characterize medical care seeking, and diagnostic and management procedures for LBP. Prevalence was computed as weighted proportions, and inference statistics used to compare medical procedures between different levels of care.

Results: A prevalence of medical care seeking for LBP of 38.0% (95%IC, 35.9 to 40.1%) was found. Primary care in isolation (45.3%), multiple care (primary plus secondary care) (28.8%) and secondary care in isolation (25.9%) were the sought levels of care for LBP. Emergency departments (25.9%) and orthopedics (19.4%) were the secondary medical specialties most used. Several distinct structural-based diagnosis and specific/ serious underlying diseases were diagnosed by physicians, mainly supported by laboratory and imaging tests performed to 91.1% of individuals. Disc herniation (20.4%) and osteoarthritis (19.7%) were the most frequent diagnosis, while x-rays (63.7%), clinical history/ observation (44.4%), blood tests (38.2%), urinalysis (34.4%), and CT scans (32.4%) were the most frequent diagnostic procedures. Only 8.5% of individuals were evaluated based on a clinical history/ observation procedure in isolation. Lastly, 75.1% of individuals self-reported being treated for LBP by their physician, 80.4% with oral medication/ pills and 15.3% with injectables. The mean duration of pharmacological treatment was 104.24 (266.80) days. The use of structural-based diagnosis, laboratory and imaging tests, and pharmacological treatment were generally aggravated when secondary care, in isolation or complementarily with primary care, was considered compared with primary care in isolation (p< 0.05).

Conclusion: Our results show that medical seeking for LBP is frequent and is associated to overdiagnosis through a diagnostic label despite there being no reliable way of determining the pathoanatomical source of pain for the great majority of patients. Medical seeking is also associated with overuse of pharmacological treatment. Funding and delivery actions should be prioritized to assure appropriate care of LBP and reduce this low-value care overuse within local health systems.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/medical-care-seeking-is-frequent-and-associated-with-overuse-of-low-value-care-for-low-back-pain-in-portugal-results-from-a-nationwide-population-based-study/