Background: Back pain is the most prevalent of musculoskeletal conditions internationally and in Australia with women reporting back pain more frequently than men. Women are higher users of health services than men more generally and tend to use complementary and alternative medicine (CAM) frequently for musculoskeletal conditions. Despite debate around evidence for CAM regarding back pain, CAM is commonly used by back pain sufferers. However, there remain important gaps in our understanding of women’s consultation patterns with CAM practitioners and self-prescribed CAM treatments for back pain.
Methods: The study utilised a Health Services Research (HSR) approach. The sample for the research reported in this thesis was obtained from a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH). In the baseline ALSWH survey (year 1996), women were randomly selected for the study in three age groups, 18-23 years (young cohort), 45-50 years (mid-age cohort) and 70-75 years (older cohort) from the national Medicare database. For the sub-study that this thesis is based on, the participants were chosen from the mid-age cohort of women, who had indicated in the sixth ALSWH survey (2010) that they had experienced back pain. Of the 10,011 women who responded to the sixth ALSWH survey, 1,851 indicated they had experienced back pain and these women were mailed a 50-item sub-study questionnaire. Subsequently 1,620 women were deemed eligible for participating in the sub-study as they confirmed that they had back pain at the time of the sub-study (2011) and 1,310 (80.9%) women returned the completed questionnaire. Alongside the women’s demographics, the survey explored the women’s patterns of consultations with CAM practitioners and self-prescribed CAM treatments, the women’s attitudes toward CAM, the influence of different information sources and communication on the women’s decision-making regarding their use of CAM for back pain. The analyses included Pearson chi-square tests to compare categorical variables and t-tests to compare continuous and categorical variables. Multiple logistic regression models, with backwards-stepwise regression, were employed to determine the significant factors associated with CAM use.
Results: A significant number of women consulted a CAM practitioner (76.4%, n=1,001) and/or self-prescribed CAM treatment (75.2%, n=985) for back pain in the previous twelve months. The most commonly consulted CAM practitioners were massage therapist, chiropractor, acupuncturist, herbalist/naturopath, meditation/yoga practitioner, osteopath and the most commonly self-prescribed CAM treatments were supplements, vitamins/minerals, yoga/meditation, herbal medicines and aromatherapy oils. Women’s attitudes toward CAM as providing greater control over their body/health, perceiving CAM as natural or promoting a holistic approach to health had a significant influence on their choice of CAM for back pain. Women’s decisions on CAM use for back pain were influenced by professional information sources (e.g., doctors; 43%, CAM practitioner; 30%, pharmacist; 20%) as well as nonprofessional information sources (e.g., friends/colleagues; 39%, family/relatives; 36%, Internet; 6%). Information sources used by women for their decision-making on CAM use differed according to their symptoms. While non-professional information sources positively influenced women in their decision to use CAM for a range of back pain related symptoms, doctors and allied health workers negatively influenced women in their decision to consult a CAM practitioner for a range of back pain related symptoms. Of the women who used CAM for their back pain, 20% consulted their GP prior to using CAM and 34% always informed their GP following CAM use.
Conclusion: This study gives insights for health care providers and policy makers on the range of CAM treatments used by back pain sufferers. Conventional medical practitioners and CAM practitioners should be aware of back pain sufferers’ decision-making regarding a range of CAM treatments and be prepared to communicate with patients on safe and effective CAM treatments for back pain. The study highlights a need for further research to examine this topic more closely, and to develop policy in relation to CAM use in back pain.