Special Poster Session 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

INTRODUCTION:  Effective management of patients with low back pain (LBP) requires a nuanced understanding of its complexity and often interconnected mechanisms. While the biomedical model primarily emphasizes pathoanatomy and the structure and function relationship, the biopsychosocial model recognizes biological, psychological, and social influences on patient outcomes. Although previous studies have explored how different healthcare providers perceive LBP, there is limited research comparing attitudes and beliefs of physicians across multiple specialties regarding LBP. Therefore, this study aims to explore the attitudes and beliefs of physicians across different specialties regarding the management of LBP and the prescribing of opioids. Considering clinical training may influence the framework used to manage patients with LBP, we anticipate there will be differences in how LBP is perceived and treated across medical specialties.

METHODS: Physicians from numerous specialties were recruited.  All participants completed an online questionnaire administered via Qualtrics.  The questionnaire included the following:  1) Demographic information, 2) Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT), 3) Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), and 4) Opioid Therapy Provider Survey (OTS). The HC-PAIRS was used to measure physicians’ attitudes and beliefs regarding the relationship between LBP and impairment, with higher scores indicating a stronger belief between pain and physical impairments.  The PABS-PT was used to differentiate between biomedical and biopsychosocial treatment orientations for patients with LBP, with higher scores indicating a stronger belief in favor of biomedical or biopsychosocial orientation.  The OTS was used to assess providers’ practice behaviors and confidence in managing their patients with opioid therapy. Descriptive statistics were used to describe the characteristics of physician groups.  Comparisons between groups were conducted using the non-parametric Mann-Whitney U test.  Data are presented as mean and range. Statistical analyses were conducted using SPSS Statistics (Version 28.0. Armonk, NY: IBM Corp) and statistical significance was set at p≤0.05.

RESULTS:  A total of 60 physicians participated in this study and represented the following specialties: Spine Surgery, n=4; Osteopathic Neuromusculoskeletal Medicine (ONMM), n=10; Family Medicine/Internal Medicine (FM) n=5, ONMM+FM, n=8; Physical Medicine & Rehabilitation (PMR), n=32; Pediatrics, n=1.  For all specialties combined, the average scores for the PABS-PT-Biomedical and PABS-PT-Biopsychosocial were 31.0 [range: 12-43], and 34.3 [range: 24-46], respectively (Figure 1).  The average HC-PAIRS score for all specialties combined was 51.2 [range: 34-75]. When comparing PMR to the other specialties combined, there was a significant difference in PABS-PT-Biopsychosocial (p=0.001) and HC-PAIRS (p=0.02), and OTS Question #5 – “I would likely prescribe opioids when other treatments are ineffective.” (p=0.04).  While statistically significant, the differences were relatively small. 

DISCUSSION: These preliminary findings suggest that physicians' attitudes and beliefs toward LBP and opioid prescribing may vary across specialties, with PMR physicians demonstrating slightly distinct perspectives compared to other specialties. While differences in treatment orientations and opioid prescribing responses were statistically significant, they were modest. Considering the small sample size across specialties, further research is needed to better understand and validate these findings.

Figure 1.  Scatter plot illustrating PABS-PT Biomedical and Biopsychosocial scores of the different medical specialties.