Description of a clinical stream of back-pain patients based on electronic medical records

Back pain consists of a spectrum of conditions, with no common etiology and therefore no dominant method of treatment. The purpose of this study is to describe the complexity of a collection of 8000 back pain patients who appeared in an integrative medicine clinic, as a prelude to conducing comparative effectiveness research on CAM alternatives to conventional therapy. Approximately 23% of all clinic patients were diagnosed at some time with back pain. Nearly half had treatment periods of less than one month, while more than 25% were treated for back pain for more than two years. Women were represented more than twice as often as men. The initial diagnosis categories that occurred most frequently were lumbar symptoms, cervical symptoms, and a general category, with smaller numbers having lumbar anatomic, thoracic symptom, brachial neuritis, or sciatica diagnoses. There were few strong relationships between initial diagnosis pattern and length of back pain treatment period. While 77% of back pain patients presented with diagnoses in only a single category, there were many composite categories each of which was sparsely represented. Between 50% and 75% of patients used some CAM service, depending on their initial diagnosis pattern. Patients with complex initial diagnosis patterns strongly tended to chose CAM, and among CAM-users those with complex diagnoses tended toward chiropractic, as opposed to acupuncture or bodywork. The CAM usage patterns of men and women were highly similar. Again among CAM users, 82% used only a single type of CAM service, and multiple service uses tend to be combined at random. Between two-thirds and three-quarters of multiple CAM service users had very simple temporal patterns of use, dominated by use of one type of CAM at a time.