Primary Care Clinician and Patient Knowledge, Interest, and Use of Integrative Treatment Options for Chronic Low Back...

Access to effective nonpharmacologic treatments for chronic pain, including integrative therapy approaches, is a priority for the US Department of Veterans Affairs (VA) for improving pain care and promoting patient-centered care as part of the VA Whole Health System care delivery model. This study sought to assess primary care practitioner (PCP) and patient knowledge, interest, and use of integrative therapies to identify strategies to promote broader utilization.

PCPs affiliated with the VA Ann Arbor Healthcare System and a random sample of patients with low back pain diagnoses were surveyed. These cross-sectional surveys assessed knowledge, use, interest, and perceived barriers.

Twenty-eight PCPs and 83 patients completed the survey, yielding response rates of 36% and 42%, respectively. Twenty-three PCPs (82%) reported recommending cognitive-behavioral therapy, 22 (79%) recommended acupuncture, and 21 (75%) chiropractic modalities for chronic pain. Fifty-nine patients (71%) reported using chiropractic and 42 (51%) used acupuncture therapies. Acupuncture, chiropractic and massage were identified as therapies that most PCPs and patients would like to have available. Twenty-six PCPs (93%) identified access to services, 22 (79%) cited time constraints, 17 (61%) cited lack of familiarity, and 18 (64%) cited lack of evidence as barriers to offering integrative therapies. Patient-identified barriers to using therapies included not knowing what services were available at their facility, not being familiar with a specific therapy, and lack of clarity about the benefits of a specific therapy.

VA PCPs and patients with chronic back pain have some experience with and are interested in using specific integrative therapies. Barriers such as service accessibility and knowledge gaps must be addressed to increase the uptake of integrative modalities for managing chronic pain.