To seek or not to seek? Care-seeking behaviour among people with low-back pain

Aim: The present study sought to identify potential differences between subjects who seek care for their low-back pain problems and those who do not with respect to pain intensity, grade of disability, physical or psychosocial working conditions, individual physical and physiological factors, and lifestyle factors. Material and methods: The study population was obtained from a population-based, case-referent study, the MUSIC-Norrtalje study. All persons with low-back pain among cases as well as "referents" were compared according to care-seeking behaviour. In all 727 cases with low-back pain who had sought care by any of 75 caregivers in the region, including all physicians and physiotherapists as well as chiropractors, osteopaths, and homeopaths, 721 referents with low-back pain who did not seek care participated. All participants underwent a clinical examination, and filled in a questionnaire about personal and occupational data, pain and disability, pain history, psychosomatic complaints, and present psychosocial situation. Results: High disability and high pain intensity were strongly related to care seeking among men and women with low-back pain. The odds ratios for high disability were 7.4 (CI 5.0 - 11.0) for women and 4.9 (CI 3.3 - 7.1) for men respectively. The odds ratios for high pain intensity were 3.7 (CI 2.2 - 6.0) for women and 1.7 (CI 1.1 - 2.8) for men. A more strained economic situation and use of passive coping strategies significantly increased the probability of women not seeking care. Neither previous pain history, high physical workload, nor jobstrain, poor job satisfaction, or life style factors (high body weight, smoking, and exercise) or psychosomatic complaints affected care-seeking behaviour. Conclusions: The most decisive factors for seeking care were disability and pain. However, numerous individuals with low disability and low pain intensity also seek care for their pain problems. Better information and advice on the common course of low-back pain may make those individuals less frightened of their pain and, as a result, reduce the consumption of care and social costs for society. The majority of people seek care for pain without wanting a medical prescription. The fact that economic factors seemed to be of importance indicates that costs for healthcare must be kept low if the goal is to give healthcare on equal terms for all.