Back Pain in Primary Care

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Abstract
Prospective study of patients making primary care visits for back pain. To examine the content of primary care visits for back pain in patients with little interference of pain with activities at the visit and 1 month later; high interference of pain with activities at the visit but not 1 month later; and high interference of pain with activities, both at the visit and 1 month later. Advice about resumption of activities may be therapeutic for patients with back pain, but little is known about the extent to which primary care providers assess and respond to limitation of activities in patients. Audiotapes of primary care visits for back pain were coded for content. Patients indicated their goals for the visit and completed measures of pain and the pain's interference with activities, just before the visit and 1 month later. In most visits, providers did not assess functional limitations related to pain and did not discuss how to resume normal activities, although this was a highly rated goal for most patients. Providers did not appear to assess or respond to patients differently according to how much pain interfered with their activities. However, in patients with high interference of pain with activities, there was more discussion of limitation of activities and how to return to usual activities among those who improved than there was among those who did not improve during the next month. Although back pain frequently is associated with limitation of activity, pain's interference with activities is assessed inconsistently in primary care visits.