AN EPIDEMIOLOGIC-STUDY OF DIAGNOSTIC AND THERAPEUTIC STRATEGIES IN OFFICE PRACTICE PATIENTS WITH SUBACUTE OR CHRONIC PAIN IN THE THORACIC OR LOW-BACK - COMPARISON OF PRACTICES IN PRIMARY-CARE AND RHEUMATOLOGY SETTINGS

There is a paucity of epidemiological data on diagnostic and therapeut ic practices in office practice patients with subacute or chronic pain in the thoracic or low back. Study objective: to describe diagnostic and therapeutic strategies used in such patients. Patients and methods : descriptive, prospective, two-month epidemiological study in 50 gene ral practitioners and 50 rheumatologists. Each physician was asked to provide data on the demographics, clinical features, history of spinal disease, investigations, prior treatments and treatments prescribed o n DO and D30 in two patients with low back pain and two with thoracic back pain, of one to 12 months' duration. Results. A total of 352 pati ents were included. In the 217 patients with low back pain, including 107 women and 110 men, duration of the pain was 4.3+/-0.2 months and m ean age was 49.6+/-1 years; 67% of these patients were economically ac tive and 22% were retired; 59% were recruited by rheumatologists. In t he thoracic back pain group, there were 135 patients, including 82 wom en (61%) and 53 men, with a mean duration of pain of 3.8+/-0.3 months and a mean age of 47.7+/-1.4 years; 60% were economically active and 2 2% were retired; 49% were recruited by rheumatologists. A history of c onservatively-treated low or thoracic back pain was reported for 95.4% of patients in the low back pain group and 94% in the thoracic back p ain group. Of the patients with low back pain, 6.3% had had spinal sur gery. Investigations were as follows: roentgenograms in 85% of low bac k pain and 75% of thoracic back pain patients, computed tomography in 11% and 5.8%, magnetic resonance imaging in 2% and 1% and laboratory t ests in 14% and 20%. Ninety-one per cent of low back pain and 84% of t horacic back pain patients were already under therapy on DO. Ninety-si x per cent of patients overall were given a prescription at the end of the DO visit, for a nonsteroidal antiinflammatory drug or an analgesi c in 80% of low back pain and 63% of thoracic back pain patients, for muscle relaxants in 62% and 69%, for drugs aimed at preventing gastric side effects in 19% and 9.5%, for myotonic agents in 10% and 8% and f or sedatives in 5% and 11%. A local steroid injection was given to 20% of low back pain patients. Twenty-four per cent of low back pain and 14% of thoracic back pain patients missed days of work (mean, 11+/-1.7 days and 13+/-4.6 days, respectively). Physical therapy was prescribe d to 36% of low back pain and 27% of thoracic back pain patients and a lumbar support belt to 17% of low back pain patients. On D3O, the pai n had abated in 86% of low back pain and 89% of thoracic back pain pat ients and complete freedom from pain was reported by 28% and 32% of pa tients in these two groups, respectively. Treatments prescribed on D3O were physical therapy (43% and 31%), analgesics (40% and 36%) muscle relaxants (25% and 30%), and nonsteroidal antiinflammatory drugs (23% and 12%). Conclusion. This preliminary study provides data on common p ractices in subacute and chronic low back and back pain and may prove useful for health care cost estimations.