Although subject to considerable research from perspectives including general practitioners, patients, and perspective guidelines, chronic low back pain (CLBP) continues to be a common but contentious condition in primary care. We used medical consultation records, critical incident interviews, and a think-aloud problem-solving task to examine how general practitioners applied professional knowledge of the condition, especially in relation to psychosocial care. Using qualitative content analysis and thematic analysis, we identified a pragmatic, goal-focused approach to patients, a schema based on biomedical knowledge and tacit theories of motivation. The doctors’ expectations for CLBP included uncertainty over symptoms and doubts over patient credibility, which helped to explain an a…
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This study is a multi-center randomized sham-controlled trial with 2 parallel arms. Participants included in the study met the following criteria: 1) low back pain lasting for at least the last 3 months, 2) a documented [greater than or equal to] 5 points on a 10 cm visual analog scale for bothersomeness of low back pain at the time of screening and 3) between 18 and 65 years of age. Participants were blinded to the real and sham acupuncture treatments. The real acupuncture treatment group received real acupuncture 2 times a week, during a total of 12 sessions over 6 weeks. The control group received sham acupuncture during the same period. In order to assess the primary and secondary outcome measures, the participants were asked to fill out a questionnaire at the baseline and 6, 8, 12 and…
Magnetic resonance imaging (MRI) is the preferred investigation for most spinal diseases and is increasingly requested for people with low back pain (LBP). However, determining the cause of back pain is complicated as it is often multifactorial and anatomical abnormalities are common in the spine and may not necessarily translate into clinical symptoms. Thus, national guidelines discourage the use of MRI in non-specific LBP and recommend reserving it for the investigation of severe or progressive neurological deficits or for those cases in which serious underlying pathology is suspected. It also has an acknowledged role in planning surgical management in cases of radiculopathy and spinal stenosis. This review summarises the indications for MRI in LBP and calls for improved education of pat…