Functional approach to treatment of back pain in primary care: a preliminary report

Back pain is one of the most common problems encountered in primary care clinics and causes great loss of work time, economy and expenditure of medical care. Knowledge of the cause of low back pain and effective treatment are rudimentary. We studied the functional approach to treatment of back pain of two acute (M:F = 1:1) and thirty chronic (M:F = 12:18) patients with back pain seen at a rural primary care clinic in September and October 1992.

Patients were included after completing an agreement form regarding the treatment plan (emphasizing therapeutic exercise, health education and as little medication as possible) in the first interview. A primary care physician specialised in family medicine personally gave treatment to the patients with free attendance to the clinic. A functional approach was adopted in four categories-therapeutic exercise, static and dynamic body biomechanics, awareness of proprioception, and maintenance of relaxed and balanced muscle tone. The patients were encouraged to perform daily activities rather than rest.

Two patients with acute back pain gained complete relief without medication, modalities, equipment or other treatment one and two weeks after the first visit, respectively. Among the 30 chronic patients, after eight weeks of treatment, 12/30 (40%) gained complete relief from pain, 4/30 (13.3%) obtained more than 3/4 and less than complete relief, 7/30 (23.3%) had more than 1/2 and less than 3/4 relief, 2/30 (6.7%) gained less than 1/2 pain relief, 1/30 (3.3%) had no improvement, 1/30 (3.3%) deteriorated, and 3/30 (10%) were lost during surveillance. The patients reported no loss of work time attributed to back pain. Two acute patients visited the clinic four times and three times, respectively. The former received three prescriptions for an upper respiratory infection one month after complete remission of back pain, and the latter received no prescriptions for medication. On average, each chronic patient visited the clinic 4.83 times in 8 weeks. In only 25 of 145 (17.2%) visits was medication prescribed for other indications, and in 8 of 145 (5.5%) visits vitamin B complex or Alinamin-F for placebo was prescribed. We used neither modalities nor equipment. Only 7/30 (23.3%) patients received concurrent treatment from other medical institutions. Regarding compliance with the programmed exercise at home, two acute patients complied well. Among the 30 chronic patients, 22 (73.3%) had good compliance, 3 (10%) had poor compliance, 2 (6.7%) failed to comply and 3 (10%) were lost in follow up.

Treating patients with back pain in primary care clinics with a functional approach by physicians appropriately trained in primary care was a good, efficacious, economic, and practical way, although neglected elsewhere. Further research and practice in our society might be worth while.