# Exploring physicians’ perspectives on influencing factors of chronic non-specific low back pain: a qualitative study

## TL;DR

This study explores how physicians view the causes of chronic low back pain and whether their views align with recommended approaches.

## Contribution

The study reveals physicians often overlook psychological and behavioral factors in chronic low back pain despite guidelines.

## Key findings

- Most physicians identified sedentary behavior as a factor, but few mentioned fear of movement or misbeliefs.
- Only half of physicians linked chronic low back pain to multiple factors in a biopsychosocial framework.
- Physicians' perspectives may unintentionally lead to harmful messages for patients with chronic low back pain.

## Abstract

This study aimed to assess physicians’ perspective of non-specific chronic low back pain (cLBP), focusing on whether they attribute the condition to single or multiple influencing factors. It also explored how these factors are conceptualised and whether physicians’ expressed attributions align with the biopsychosocial approach advised in the guidelines for the management of cLBP.

This exploratory qualitative study used a clinical vignette depicting cLBP and employed a deductive framework analysis. Licensed general practitioners and trainees were asked to identify contributing factors to the patient’s cLBP. Five predefined themes, ‘Beliefs’, ‘Previous experiences’, ‘Emotions’, ‘Patients behaviour’ and ‘Contextual factors’, were analysed to assess their framing within a biopsychosocial approach.

Seventy-six physicians participated. They used very brief responses when reporting contributing factors to cLBP (median: 11 words). While 71% identified sedentary behaviour as a contributing factor, only 28% mentioned fear of movement and 8% identified the misbeliefs embedded in the vignette. Half of the participants linked the patient’s cLBP to multiple factors, yet 38% of those responses were exempt from segments ‘less aligned’ with a biopsychosocial approach.

Physicians generally provided a multifactorial perspective on cLBP, yet relevant factors such as identifying misbeliefs were often overlooked. Approximately, three-quarters did not mention fear of movement, despite evidence supporting this link. Physicians need to be aware of how their perspective can shape potentially harmful or stigmatizing messages, which may contribute to poorer outcomes for patients with cLBP. Given the methodological limitations, further qualitative research is needed to confirm and expand on these findings.