Low back pain management attitudes and pharmacy practice: the impact of community pharmacists’ characteristics.

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Ammar Abdulrahman Jairoun https://orcid.org/0000-0002-4471-0878
Sabaa Saleh Al-Hemyari https://orcid.org/0000-0002-0795-3408
Moyad Shahwan https://orcid.org/0000-0001-8367-4841
Eman Abu-Gharbieh https://orcid.org/0000-0002-5972-0681
Sa’ed H. Zyoud https://orcid.org/0000-0002-7369-2058
Ammar Ali Saleh Jaber https://orcid.org/0000-0003-0411-1923
Maimona Jairoun https://orcid.org/0000-0002-9828-8596


Low back pain, Knowledge, Attitude, Community pharmacy, Beliefs


Background: Low back pain (LBP) is one of the most frequent diseases for which patients seek advice in a community pharmacy. There is evidence to suggest that LBP-related negative beliefs are associated with increased levels of pain and impairment. Objective: This study evaluated the attitudes, beliefs, and practices of community pharmacists who advise patients with acute or chronic LBP. Methods: This is a cross-sectional study conducted among licensed community pharmacists, which were selected randomly in Abu Dhabi, Dubai, and the Northern Emirates. The survey took place via a questionnaire and face-to-face interviews. The questionnaire covered questions on demographics and the participants’ attitudes, beliefs, and practices regarding LBP management. Multivariate logistic regression was employed to identify the factors influencing respondents’ practices in relation to LBS therapy, while multivariate linear regression was used to identify the factors influencing respondents’ attitudes toward LBP management. Results: A total of 867 participants enrolled in the study. 63% were female, 53.9% of the surveyed pharmacies were independent pharmacies, 68.9% had more than ten years of experience, 55.7% graduated from regional/international universities, 84.5% were Bachelor’s degree holders, and 63.5% were Pharmacists in charge. Bivariate analysis showed that chain pharmacies (P <0.001), having more than ten years of experience (P< 0.001), graduated from regional/international universities (P < 0.001), and pharmacists in charge (P <0.001) were more likely to score higher in attitude and practice towards the management of LBP. Conclusion: Community pharmacists in the UAE have a positive attitude and practice when it comes to managing lower back pain. Community pharmacists’ recommendations for low back pain care in the UAE largely coincide with clinical practice for low back pain

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1. Andersson G. Epidemiology of low back pain. Acta Orthop Scand Suppl. 1998;281(4):28-31. https://doi.org/10.36076/ppj.2000/3/167
2. James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990–2017: A systematic analysis forthe Global Burden of Disease 
Study 2017. Lancet. 2018;10(Suppl 5):1789-1858. https://doi.org/10.1200/jco.2018.36.15_suppl.1568
3. Jarvik JG, Hollingworth W, Heagerty PJ, et al. Three-year incidence of low back pain in an initially asymptomatic cohort: Clinical and imaging risk factors. Spine. 2005;30(13):1541-1548. https://doi.org/10.1097/01.brs.0000167536.60002.87
4. Walker BF. The prevalence of low back pain: A systematic review of the literature from 1966 to 1998. J Spinal Disord. 2000;13(3):205-217. https://doi.org/10.1097/00002517-200006000-00003
5. Burton AK, Balagué F, Cardon G, et al. How to prevent low back pain. Best Pract Res Clin Rheumatol. 2005;19(4):541-555. https://doi.org/10.1016/j.berh.2005.03.001
6. Grabovac I, Dorner TE. Association between low back pain and various everyday performances: Activities of daily living, ability to work and sexual function. Wien Klin Wochenschr. 2019;131(21-22):541-549. https://doi.org/10.1007/s00508-019-01542-7
7. van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in The Netherlands. Pain. 1995;62(2):233-240. https://doi.org/10.1016/0304-3959(94)00272-G
8. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 
2018;391(10137):2356-2367. https://doi.org/10.1016/S0140-6736(18)30480-X
9. Caneiro JP, Bunzli S, O’Sullivan P. Beliefs about the body and pain: the critical role in musculoskeletal pain management. Braz J PhysTher. 2021;25(1):17-29. https://doi.org/10.1016/j.bjpt.2020.06.003
10. Leventhal H, Phillips LA, Burns E. The Common-Sense model of self-regulation (CSM): a dynamic framework for understanding illness self-management. J Behav Med. 2016;39(6):935-946. https://doi.org/10.1007/s10865-016-9782-2
11. Bunzli S, Smith A, Schutze R, et al. Beliefs underlying pain-related fear and how they evolve: a qualitative investigation in people with chronic back pain and high pain-related fear. BMJ Open. 2015;5(10):e008847. https://doi.org/10.1136/
12. Bunzli S, Smith A, Schutze R, et al. Making sense of low back pain and pain-relatedfear. J Orthop Sports Phys Ther. 2017;47(9):628-636. https://doi.org/10.2519/jospt.2017.7434
13. Philips HC. Avoidance behaviour and its role in sustaining chronic pain. Behav Res Ther. 1987;25(4):273-279. https://doi.org/10.1016/0005-7967(87)90005-2
14. Morton L, de Bruin M, Krajewska M, et al. Beliefs about back pain and pain management behaviours, and their associations in the general population: a systematic review. Eur J Pain. 2019;23(1):15-30. https://doi.org/10.1002/ejp.1285
15. de Raaij EJ, Ostelo RW, Maissan F, et al. The association of illness perception and prognosis for pain and physical function in patients with noncancer musculoskeletal pain: a systematic literature review. J Orthop Sports Phys Ther. 2018;48(10):789-800. 
16. Airaksinen O, Brox JI, Cedraschi C, et al. On behalf of the COST B13 Working Group on Guidelines for Chronic Low Back Pain: European guidelines for the management ofchronic non-specific low back pain. European Spine Journal. 2006;15(Suppl 
17. van Tulder M, Becker A, Bekkering T, et al. On behalf of the COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care: European guidelines forthe management of acute non-specific low back pain in 
primarycare. European Spine Journal. 2006;15(Suppl 2):169-191.
18. Hart LG, Deyo RA, Cherkin DC. Physician visits for low back pain: Frequency, clinical evaluation, and treatment patterns for a U.S. National Survey. Spine. 1995;20(1):11-19. https://doi.org/10.1097/00007632-199501000-00003
19. Gyllenhammer D, Sickinger M, Gyllenhammer RT. The Community Pharmacist’s Role in Managing Lower Back Pain. US Pharm. 2017;42:35-38.
20. Dineen-Gri S, Cert G, Garcia-Cardenas V, et al. Evaluation of a collaboratorive protocolized approach by community pharmacists and general medical practitioners for an Australian minor ailments scheme: Protocol for a cluster randomized controlled trial. 
JMIR Res Protoc. 2019;8(8):e13973. https://doi.org/10.2196/13973
21. Aly M, Garcia-Cardenas V, Williams K, et al. A review of international pharmacy—Based minor ailment schemes a substitute for other service providers? A systematic review. Res Soc Adm Pharm. 2018;14(11):989-998. https://doi.org/10.1016/j.
22. Slater H.; Briggs AM, Watkins K, et al. Translating evidence for low back pain management into a consumer—Focused resource for use in community pharmacies: A cluster-randomized controlled trial. PLoS ONE. 2013;8:e71918. https://doi.org/10.3410
23. Miggos S. Mal di schiena (Lombalgia). In Inquadramento Clinico e Gestione dei Disturbi Minori in Farmacia; Giua Marassi, C., Ed.; Edra: Milan, Italy. 2017;51-54.
24. Houben RMA, Ostelo RWJG, Vlaeyen JWS, et al. Health care providers’ orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity. European Journal of 
Pain. 2005;9(2):173-184. https://doi.org/10.1016/j.ejpain.2004.05.002
25. Rainville J, Carlson N, Polatin P, et al. Exploration of physicians’ recommendations for activities in chronic low back pain. Spine. 2000;25(17):2210-2220. https://doi.org/10.1097/00007632-200009010-00012
26. Pincus T, Foster NE, Vogel S, et al. Attitudes to back pain amongst musculoskeletal practitioners: a comparison of professional groups and practice settings using the ABS-mp. Manual Therapy. 2007;12(2):167-175. https://doi.org/10.1016/j.
27. Linton SJ, Vlaeyen J, Ostelo R. The back-pain beliefs of health care providers: are we fear-avoidant? Journal of Occupational Rehabilitation. 2002;12(4):223-232. https://doi.org/10.1023/a:1020218422974
28. Grøn S, Jensen RK, Kongsted A. Beliefs about back pain and associations with clinical outcomes: a primary care cohort study. BMJ open. 2022;12(5):e060084. https://doi.org/10.1136/bmjopen-2021-060084
29. Silcock J, Moffett JK, Edmondson H, et al. Do community pharmacists have the attitudes and knowledge to support evidence based self-management of low back pain? BMC Musculoskeletal Disorders. 2007;8(1):1-8. https://doi.org/10.1186/1471-
30. Giua C, Minghetti P, Gandolini G, et al. Community Pharmacist’s Role in Detecting Low Back Pain, and Patient Attitudes—A Cross-Sectional Observational Study in Italian Community Pharmacies. International Journal of Environmental Research and 
Public Health. 2020;17(16):5965. https://doi.org/10.3390/ijerph17165965
31. Lawshe C. A quantitative approach to content validity. Pers Psychol. 1975;28(4):563-575. https://doi.org/10.1111/j.1744-6570.1975.tb01393.x
32. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459-467. https://doi.org/10.1002/nur.20199
33. Symonds TL, Burton AK, Tillotson KM, et al. Do attitudes and beliefs influence work loss due to low back trouble? Occup Med. 1996;46(1):25-32. https://doi.org/10.1093/occmed/46.1.25
34. Emirates News Agency. UAE has over 2000 private pharmacies, 4000 professionals. 2010 Available at URL: http://wam.ae/en/details/1395228626943
35. Bernardi M, Catania G, Lambert A, et al. Knowledge and attitudes about cancer pain management: a national survey of Italian oncology nurses. Eur J Oncol Nurs. 2007;11(3):272-279. https://doi.org/10.1097/01.ncc.0000265299.25017.24
36. Hadi MA, Alldred DP, Briggs M, et al. Effectiveness of pharmacist-led medication review in chronic pain management: systematic review and meta-analysis. Clin J Pain. 2014;30(11):1006-1014. https://doi.org/10.1097/AJP.0000000000000063
37. Giua C, Minghetti P, Gandolini G, et al. Community Pharmacist’s Role in Detecting Low Back Pain, and Patient Attitudes—A Cross-Sectional Observational Study in Italian Community Pharmacies. International Journal of Environmental Research and 
Public Health. 2020;17(16):5965. https://doi.org/10.3390/ijerph17165965
38. Dabbous, Mariam, Moustafa, et al. Knowledge, attitude and practice of Lebanese community pharmacists with regard to selfmanagement of low back pain. Tropical Journal of Pharmaceutical Research. 2020;19(4):873-878. https://doi.org/10.4314/
39. Shaheed CA, Maher CG, Mak W, et al. The effects of educational interventionson pharmacists’ knowledge, attitudes and beliefs towards low back pain. Int J Clin Pharm. 2015;37(4):616-625. https://doi.org/10.1007/s11096-015-0112-5
40. Wilk V, Palmer HD, Stosic RG, et al. Evidenceand Practice in the Self-Management of Low Back Pain:Findings From an Australian Internet-based Survey. Clin J Pain. 2010;26(6):533-540. https://doi.org/10.1097/ajp.0b013e3181dc7abb
41. Nasser M Alorfi, Ahmed M Ashour, Alanood S Algarni, et al. Assessment of the Community Pharmacists’ Knowledge and Attitudes Toward Pain and Pain Management in Saudi Arabia. International Journal of General Medicine. 2022;15:8527-
8537. https://doi.org/10.2147/ijgm.s387066
42. Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142(4):260-273. https://doi.org/10.7326/0003-4819-142-4-200502150-00008
43. Patel T, Chang F, Mohammed HT, et al. Knowledge, Perceptions and Attitudes toward Chronic Pain and Its Management: A Cross-Sectional Survey of Frontline Pharmacists in Ontario, Canada. PLoS ONE. 2016;11(6):e0157151. https://doi.org/10.1371/

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