Management of low back pain in primary care prior to multidisciplinary functional restoration: A retrospective study of 72 patients

Bouton, Céline; Roché, G; Legrand, Érick; Penneau-Fontbonne, D.; Dubus, V.; Bontoux, L.; Huez, Jean-François; Rucay, Pierre; Parot-Shinkel, Elsa; Fanello, S.; Rodet-Belarbi, Isabelle

doi:10.1016/j.annrmp.2008.08.006

Cited by 11 publications

(7 citation statements)

References 32 publications

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Section: Discussionmentioning

confidence: 99%

“…Third, patients with somatoform disorder, who often are subjected to redundant medical examinations over many years, may show much longer delay in seeking psychotherapy than patients with depression. 13 Moderators A secondary aim of our meta-analysis was to examine moderators of treatment effects. However, moderator analyses reported here should be interpreted with considerable caution.…”

Section: Studymentioning

confidence: 99%

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Effectiveness of psychotherapy for severe somatoform disorder: meta-analysis

et al. 2014

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Somatoform disorders are characterised by persistent physical symptoms that suggest the presence of a medical condition, but are not explained fully by that condition or by the direct effects of substance misuse or mental disorder (DSM-IV).1 The prevalence of somatoform disorders is estimated at 6% in the general population.2 Patients with such disorders usually have high functional impairment, 3,4 are difficult to treat, 5,6 and show high utilisation of medical care. 7 Moreover, it typically takes years before they are referred to mental healthcare. 6,8,9 A strictly somatic approach and unnecessary diagnostic examinations may increase somatising behaviours, 10 and lead to chronic symptoms and high medical costs: 7,11,12 these findings emphasise the need for early intervention.13 Psychotherapy may be a viable treatment option given the role of behavioural, cognitive and emotional processes in these disorders and their high degree of comorbidity with mental disorders.14-16 Some reviews and meta-analyses suggest that psychotherapy may be effective in patients with somatoform disorder. [17][18][19] However, these reviews were restricted to psychodynamic psychotherapy only, 17 or predominantly involved groups with less severe disorder, with functional neurological or conversion disorder generally being excluded. 18 Hypochondriasis and body dysmorphic disorder were typically included in these reviews, 19 although it is still a matter of debate whether these conditions should be classified as somatoform disorder.14, 20 The results of previous reviews cannot always be generalised to patients with strictly defined somatoform disorder in secondary and tertiary care, as these patients are generally more impaired than those seen in primary care. 21 Finally, previous meta-analyses typically included only randomised trials, often excluding effectiveness studies, [22][23][24] whereas the inclusion of both randomised and non-randomised studies allows the meta-analytic comparison of effect sizes between these designs.The aim of our meta-analysis therefore was to examine the effectiveness of psychotherapy for patients with strictly defined, severe somatoform disorder treated in secondary and tertiary care. To that aim, we compared effect sizes from pre-to post-treatment and from post-treatment to follow-up of psychotherapy and treatment as usual, excluding waiting-list control groups. This study focused on pre-to post-treatment contrasts, and not on between-group contrasts, given the limited number of controlled treatment studies in this context. Given the small number of studies included, moderators of treatment effect were examined only exploratively. We examined methodological quality of the studies, 25 intervention characteristics (type, modality, frequency and length), 26 and whether treatment was offered in tertiary (multimodal and integrative) or secondary care settings, 18 as potential factors influencing treatment effectiveness. MethodA multiple-phase search was conducted in March 2010 to retrieve as many studies as pos...

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Section: Discussionmentioning

confidence: 99%

Section: Studymentioning

confidence: 99%

Effectiveness of psychotherapy for severe somatoform disorder: meta-analysis

et al. 2014

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“…However, the vast majority of patients with chronic diseases in France are seen by GPs, even if patients sometimes consult specialists directly. There is evidence that this is particularly the case for LBP, where even the most severe patients are seen over a long period of time by their GPs [11]. Self-medication occurs rarely, if the respective drugs are also reimbursed, as is the case for paracetamol or ibuprofen, both available OTC and reimbursed if prescribed.…”

Section: Discussionmentioning

confidence: 99%

“…A random sample of 1000 primary care physicians was selected from the overall General Practitioner (GP) population to select 100 responders, who were each asked to include 10 consecutive patients for a final objective of 1000 patients in the study. Patients identified in this way are representative of those suffering from LBP in the general population with even severe cases regularly consulting their GP [11]. Patients should: (i) be aged 35-75 years; (ii) have LBP at least once a week for at least 3 months at time of inclusion, and (iii) consent to participate in the study.…”

Section: Study Design and Populationmentioning

confidence: 99%

Medical and non‐medical direct costs of chronic low back pain in patients consulting primary care physicians in France

Depont

Hunsche²,

Abouelfath

et al. 2010

Fundamemntal Clinical Pharma

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A retrospective, observational, cohort study in primary care. To determine the total direct medical and non-medical cost of chronic low back pain (LBP) in France and its associated factors. Chronic LBP affects 5-10% of the population its burden in France is unknown. Ninety-eight randomly selected general practitioners included 796 adult patients with chronic LBP between October 2001 and December 2002. Direct costs due to physician visits, investigations, medications, hospitalizations, and other medical and non-medical resource use were collected for the 6 months prior to study visit. Costs both reimbursed and not by the French health insurance system were considered. Quality of life (QoL) and disease severity were measured using Short Form (SF)-8 and Roland-Morris disability questionnaire (RMDQ), respectively. Costs were updated to represent 2007 prices. Men represented 50.6% of the 796 patients, mean age was 53 +/- 11.3 years, and the duration of LBP was more than 1 year in 80.9% of patients. The total mean cost per patient over six months was 715.6 euro (95% CI: 644.2-797.8). Of these costs, 22.9% related to care provided by physiotherapists and allied specialists, 19.5% to medications, 17.4% to hospitalizations, 9.6% to investigations, and 12.5% to physician fees. In multivariate analysis, the factors associated with the cost of chronic LBP were disease severity (RMDQ score) and age of the patients. LBP is a disease that is both common and costly.

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“…In our survey, GPs would mostly refer their patients to a surgeon, suggesting that they would rather consider surgical than conservative treatment for people with LSS. A study assessing the management of LBP in primary care found similar results [21]: rheumatologists were consulted in 93% and surgeons in 60%. Several GPs reported that they would not refer their patients to a specialist in PMR because of the lack of accessibility to this specialty.…”

Section: Discussionmentioning

confidence: 72%

Diagnosis and management of lumbar spinal stenosis in primary care in France: a survey of general practitioners

Chagnas

Poiraudeau

Lefèvre-Colau

et al. 2019

BMC Musculoskelet Disord

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Background Lumbar spinal stenosis (LSS) is a common spinal condition and the most frequent indication for spinal surgery in elderly people. General practitioners (GPs) are on the 1st line for its diagnosis and treatment. We aimed to assess how GPs diagnose and treat people with LSS in France. Methods We conducted a cross-sectional survey in a primary care setting. French GPs were selected by a random draw from the French Medical Board. The questionnaire was designed by 3 physicians specialized in physical and rehabilitation medicine and a resident in general practice. A provisional questionnaire was tested in a pilot survey of 11 French GPs. Participants’ feedbacks served to build the final questionnaire. This latter was submitted by e-mail or mail to 330 GPs. GPs were surveyed about the 3 main domains relevant to the management of people with LSS in primary care: 1/ diagnosis, 2/ pharmacological treatments and 3/ non-pharmacological treatments, using self-administered open- and closed-ended questions and visual analog scales. Results Overall, 90/330 (27.3%) GPs completed the survey. 51/89 (57.3%) GPs were confident with managing people with LSS. Low back pain 51/87 (58.6%), neurogenic claudication 38/87 (43.7%) and paresthesia in the lower limbs 31/87 (35.6%) were the 3 most frequently cited clinical signs leading to the diagnosis of LSS. Improvement with lumbar flexion was mentioned by 9/87 (10.3%) GPs. 85/86 (98.8%) would consider prescribing lumbar imaging, 60/84 (71.4%) corticoid spinal injections and 42/79 (53.2%) would never prescribe lumbar flexion-based endurance training. All GPs would refer people with LSS to another specialist. Conclusions French GPs lack confidence with diagnosing LSS and prescribing pharmacological and non-pharmacological treatments for people with LSS.

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Management of low back pain in primary care prior to multidisciplinary functional restoration: A retrospective study of 72 patients

Abstract: The time interval before referral to a multidisciplinary care team is long and so GPs should be encouraged and helped to organize this process earlier. It is also essential to determine factors which predict progression to chronic LBP.

Cited by 11 publications

References 32 publications

Effectiveness of psychotherapy for severe somatoform disorder: meta-analysis

Effectiveness of psychotherapy for severe somatoform disorder: meta-analysis

Medical and non‐medical direct costs of chronic low back pain in patients consulting primary care physicians in France

Diagnosis and management of lumbar spinal stenosis in primary care in France: a survey of general practitioners

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