Table 7 Statements by primary health care providers about the difficulties in the clinical approach to chronic low back pain

Primary health care providers versus pharmacological treatment of chronic low back pain

“Mainly NSAIDs, non-steroidal anti-inflammatory drugs, and depending on age, either paracetamol or diclofenac or ibuprofen. And then, because later they would be plotted and then if there was root affectation with paraesthesia or neuralgia or something, then we would give the gabapentin” (BM 3)

“People seek immediacy, the immediate solution, they have a false expectation of medicine. There are many factors that influence them, and they do not accept them” (BM 2)

“The pharmacological route is very powerful. Today no one has had pain, no one. Furthermore, I believe that it is considered medical malpractice for a patient to have pain” (RN 5)

“We give him little solution and as a doctor you feel a little helpless [...] I think there would surely be other professionals more suited to treat him. More effectively at least” (BM 1)

“If he doesn’t get better I’d rather have him treated by another professional because I do not offer him anything” (BM 5).

“Poor pain control and if I see something in the complementary tests, since what we were saying is a disk disease, which you can see is compressive, then I also make a referral [...] When I send him to rehab it is because they usually make them a school of the back to work on postures, like sitting, like taking weights [...] I don’t think they get better. I think they are given instruments, let’s say, to help them live with the pain” (BM 4).

“The patient just complains. That I am in pain, that I have functional impotence that, I am in pain. So, if I’ve finished the therapeutic arsenal and I do not see anything that can be done, then I’ll send you to the orthopaedic surgeon [...] At least you can be sure that the specialist already agrees with you” (BM 3).

Barriers in primary health care provider-patient communication

“Everyone’s pain threshold is very questionable. But of course, if they tell you that they have a pain because you eradicate it, you go towards that pain at the level of the lower back” (RN 2).

“Real, for them, I guess. The thing is that it’s subjective, because sometimes I think of a person who comes in and tells me a pain that maybe for him is very intense and I think that maybe it’s less” (BM 5).

“They come to you at sixty years old or sixty-something who are waiting to retire and then retire at once [...] And then you never know if they have the pain or increase it looking for some benefit, because I want a disability” (BM 3)

“In our practice we have to treat the pain of that person, the analysis, hypertension... Then, the pain will not kill him because there it is. We try to focus it, treat it and help it. But let’s say that it also surpasses us a little [...] probably what the patient is most concerned about is the pain, but probably what I am least concerned about is the pain. Although I understand that it affects his quality of life a lot” (BM 4).

“A pain of chronic characteristics will not improve in three days with the treatment we do either” (BM 1).

“Always all the education we give our patients about any health problem when they leave, first of all they will get half or less of what I say, because people are blocked, you are in a consultation and then they are telling you that you have lumbago [...] that this can happen to you, that the other can happen to you, that treatment is here and there, that this is forever, that this has no cure, that this is a life sentence. So, all that information that reaches the patient is blocked, and then it goes away. Of what you have told him, what does he get, 40%? Of that 40, 20% is agreed upon, and so at the end, a residual 10% remains as a reminder of the interview you had with him” (BM 3).

The need for primary health care providers to acquire new knowledge about pain

“From the primary school management, they offer specific training in pain management. But the truth is that the approach is always pharmacological [...] well, of course, we do have pharmacological knowledge and the latest developments in drugs as well, but little else” (BM 1).

“How can we approach that chronic patient who has taken everything? How can I approach him to control all the symptoms a little? Not only medication, a more complete, more global approach [...] Alternative things to pharmacology, rehabilitation. Different alternative things. Even on a psychological level” (BM 2).

“I’d like to be given the keys to dealing with it successfully, basically” (BM 4).