Chenot Jean-François, Becker Annette, Leonhardt Corinna, Keller Stefan, Donner-Banzhoff Norbert, Baum Erika, Pfingsten Michael, Hildebrandt Jan, Basler Heinz-Dieter, Kochen Michael M
Dpt. of General Practice, University of Göttingen, Humboldtallee 38, 37073 Göttingen, Germany.
BMC Complement Altern Med. 2007 Dec 18;7:42. doi: 10.1186/1472-6882-7-42.
Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain.
This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months
A total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM.
The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.
尽管背痛被认为是患者寻求补充和替代医学（CAM）疗法的最常见原因之一，但对于患者实际使用CAM治疗背痛的程度知之甚少。
这是一项对嵌入随机对照试验的纵向前瞻性队列研究的事后分析。全科医生（GPs）连续招募患有下背痛的成年患者。在首次会诊时以及为期十二个月的随访电话访谈中收集有关身体功能、主观情绪和卫生服务利用情况的数据。
根据定义，1342名患者中分别有691名（51%）和928名（69%）接受了一种形式的CAM。局部热敷、按摩和脊柱推拿是最常提供的CAM形式。使用CAM与专科护理、慢性下背痛以及在康复机构接受治疗有关。接受脊柱推拿、针灸或经皮电刺激神经疗法（TENS）与咨询提供这些服务的全科医生有关。除了慢性病相关因素外，功能能力或疼痛等因素与接受CAM的关联仅为微弱或无关联。
CAM在治疗下背痛方面的频繁使用表明CAM在患者和医生中都很受欢迎。观察到的与在康复机构接受治疗或专科会诊的关联，更多地反映了医生的专业偏好，而非明确的医学指征。观察到的对提供者及与提供者相关服务的依赖，以及很大一部分接受CAM但不符合迄今既定选择标准的情况，表明CAM的使用存在一些随意性。
