• Judith M Sieben, Johan W S Vlaeyen, Piet J M Portegijs, Franca C Warmenhoven, Ageeth G Sint, Nadine Dautzenberg, Arnold Romeijnders, Arnoud Arntz, and J André Knottnerus.
• Department of Anatomy and Embryology, Maastricht University, Maastricht, The Netherlands. j.sieben@ae.unimaas.nl
• Eur J Pain. 2009 Apr 1;13(4):412-8.

BackgroundIn low back pain (LBP) treatment and research attention has shifted from a biomedical towards a biopsychosocial approach. Patients' LBP beliefs and attitudes were found to predict long-term outcome, and recently it has been suggested that the health care providers' ideas about LBP are also important predictors of treatment behaviour and outcome.AimsIn the present study we examined whether (1) differences in General Practitioners' (GP) LBP treatment orientation are associated with differences in actual treatment behaviour and (2) whether treatment orientation is related to LBP outcome in patients.MethodsTwo hundred twenty two patients consulting their GP with a new episode of LBP were recruited and completed questionnaires on (among others) LBP outcome (graded chronic pain scale) at baseline, during 12 months of follow-up and at the end of the study. Data on treatment were collected from the GPs. The GPs also completed a set of questionnaires on LBP treatment orientation. Associations between measures of treatment orientation, treatment recommendations, treatment behaviour and LBP outcome were analysed.ResultsA biomedical treatment orientation was found to be associated with more concern about tissue damage and the effect of physical activity on pain and recovery in vignettes. No associations were found between treatment orientation measures, actual treatment behaviour and LBP outcome.ConclusionsAssociations were not found as expected. Still these findings are relevant and may feed a clinically important debate on widely accepted assumptions about the role and influence of health care providers in changing patients' pain behaviours.

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