Conceptualization and evaluation of an optimal healing environment for chronic low-back pain in primary care

This paper describes what a primary care-based optimal healing environment (OHE) might look like for chronic low-back pain, and presents a research protocol to evaluate the effect of such an environment on a variety of important patient and clinician outcomes. Such an environment may be conceived of as having three major components: (1) the health care environment in which the primary care team works; (2) the cognitive, technical, clinical and organizational skills of the team, and; (3) the "healing" skills of the team members, particularly the primary care physician. A variety of study designs available for evaluating the effects of an OHE on patient and clinical outcomes are described. Decisions about study site and population, appropriate outcome measures, required sample sizes, methods of patient recruitment, treatment protocol and analytic issues would need to be tailored to the specific requirements of the study. Because many elements of an OHE designed for chronic back pain seen in primary care settings would also be relevant for the other 98% of primary care visits, it is preferable to design, implement and evaluate an OHE for primary care practice in general than for only a specific condition.