Journal of General Internal Medicine

, Volume 13, Issue 5, pp 289–295 | Cite as

Reasons for repeated medical visits among patients with chronic back pain

  • Carol A. McPhillips-Tangum
  • Daniel C. Cherkin
  • Lorna A. Rhodes
  • Christine Markham
Original Articles

Abstract

OBJECTIVE: This study identifies the key motivations of patients repeatedly seeking medical care for chronic back problems.

DESIGN: We conduced one-on-one, in-depth interviews with patients to discuss their experiences with low back pain and its care. To validate our interpretation of the qualitative data, participants were mailed questionnaires listing the themes identified in the interviews and asked to rate the importance to them of each of the themes.

SETTING: Managed health care plans in Atlanta, Dallas, and Seattle.

PARTICIPANTS: Fifty-four patients (37% male, 63% female) who were 25 to 65 years of age and had three or more medically attended episodes of low back pain during the 3 years preceding the study.

MAIN RESULTS: In describing their motivations for seeking medical care for back pain, nearly all participants cited difficulty in performing normal activities and the desire to discover the cause of the pain. Other motivations for seeking medical care for back pain included increased pain and the desire for a diagnostic test or a new treatment. Many of the verbalized reasons for repeated medical visits among patients with chronic back pain are probably best understood as seeking validation of their suffering.

CONCLUSIONS: Patients with chronic back pain report many unmet needs and expectations. Overall satisfaction might be improved if clinicians elicit patients’ views of underlying causes and their expectations from office visits.

Key words

back pain low back pain chronic pain repeated medical visits 

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References

  1. 1.
    Deyo RA, Yuh-Jane TW. Descriptive epidemiology of low-back pain and its related medical care in the United States. Spine. 1987;12:264–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Deyo RA, Cherkin D, Conrad D, Volinn E. Cost, controversy, crisis: low back pain and the health of the public. Annu Rev Public Health. 1991;12:141–56.PubMedCrossRefGoogle Scholar
  3. 3.
    Frymoyer JW. Back pain and sciatica. N Engl J Med. 1988;318:291–300.PubMedCrossRefGoogle Scholar
  4. 4.
    Cypress BK. Characteristics of physician visits for back symptoms: a national perspective. Am J Public Health. 1983;73:389–95.PubMedGoogle Scholar
  5. 5.
    Andersson GBJ, Pope MH, Frymoyer JW, Snook S. Epidemiology and cost in occupational low back pain. In: Pope MH, Andersson GBJ, Frymoyer JW, Chaffin DB, eds. Occupational Low Back Pain: Assessment, Treatment and Prevention. St. Louis, Mo: Mosby-Year Book; 1991:95–113.Google Scholar
  6. 6.
    Deyo RA. Conservative therapy for low back pain: distinguishing useful from useless therapy. JAMA. 1983;250:1057–62.PubMedCrossRefGoogle Scholar
  7. 7.
    Spitzer WO, LeBlanc FE, Dupuis M. Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for physicians: report of the Quebec Task Force on Spinal Disorders. Spine. 1987;12(suppl):S1–59.Google Scholar
  8. 8.
    Cherkin D, Deyo RA, Berg AO. Evaluation of a physician education intervention to improve primary care for low-back pain, II: impact on patients. Spine. 1991;16:1173–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Cherkin D, Deyo RA, Berg AO, Bergman JJ, Lishner DM. Evaluation of a physician education intervention to improve primary care for low-back pain, I: impact on physicians. Spine. 1991;16:1168–72.PubMedCrossRefGoogle Scholar
  10. 10.
    US Department of Health and Human Services. Acute Low Back Problems in Adults: Clinical Practice Guideline. Washington, DC: US Government Printing Office; 1994. AHCPR publication 95-0642.Google Scholar
  11. 11.
    Cherkin DC, Deyo RA, Volinn E, Loeser JD. Use of the International Classification of Diseases (ICD-9-CM) to identify hospitalizations for mechanical low back problems in administrative databases. Spine. 1992;17:817–25.PubMedCrossRefGoogle Scholar
  12. 12.
    Shekelle PG, Markovich M, Louie R. Factors associated with choosing a chiropractor for episodes of back pain care. Med Care. 1995;33:842–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Thomas KB. General practice consultations—is there any point in being positive? BMJ. 1987;294:1200–2.PubMedCrossRefGoogle Scholar
  14. 14.
    Bass MJ. The physician’s actions and the outcome of illness in family practice. J Fam Pract. 1986;23:43–7.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 1998

Authors and Affiliations

  • Carol A. McPhillips-Tangum
    • 1
  • Daniel C. Cherkin
    • 2
  • Lorna A. Rhodes
    • 3
  • Christine Markham
    • 4
  1. 1.The Prudential Center for Health Care ResearchAtlanta
  2. 2.Center for Health StudiesGroup Health Cooperative of Puget SoundSeattle
  3. 3.University of WashingtonSeattle
  4. 4.Houston Health Science CenterUniversity of TexasUSA

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