Clinical practice variation in chronic spine pain care: A multispecialty study
Hassan Moria, Saleh Alatawi, Bandr Mohammed Alenazi, Amirah M. Alatawi, Abdulwhab Ali Alataw, Sadeem Alruwaili, Yazeed Alanazi, Saleh Abdulrhman Alenzi, Mishari BeragdarObjectives:
Chronic spine pain is a highly prevalent condition that requires coordinated, guideline-concordant care integrating pharmacological management, psychosocial assessment, and appropriate diagnostic evaluation. However, variations in clinical practice across physician specialties may influence the consistency of chronic spine pain management. This study examines specialty-related variation in chronic spine pain management practices among physicians in Tabuk, Saudi Arabia, and to identify differences in selected evidence-based clinical behaviors.
Materials and Methods:
A cross-sectional survey was conducted among physicians practicing in Tabuk, Saudi Arabia. A total of 210 physicians were invited, and 105 completed the survey (response rate 50%). The structured questionnaire assessed physician demographics, self-rated confidence in managing chronic spine pain, and key clinical practices including nonsteroidal anti-inflammatory drugs (NSAID) risk counseling, psychosocial screening using patient health questionnaire-9 (PHQ-9) and GAD-7, opioid prescribing, red-flag screening, focused physical examination prior to magnetic resonance imaging (MRI), and referral to pain specialists. Differences across specialties were assessed using the Kruskal–Wallis test for confidence scores and chi-square or exact tests for categorical practice variables. Pain Medicine was excluded from inferential comparisons because only one respondent represented this specialty.
Results:
A total of 105 physicians participated, including 52 Family Medicine physicians (49.5%), 24 Orthopedic Surgeons (22.9%), 15 Neurologists (14.3%), and 13 Neurosurgeons (12.4%). Self-rated confidence differed significantly across specialties ( p = 0.0027), with the highest mean scores reported in Neurology (4.40 ± 0.83) and Neurosurgery (4.23 ± 1.54), and the lowest in Orthopedic Surgery (3.21 ± 1.02). Across most clinical domains, including opioid prescribing, red-flag screening, focused examination prior to MRI, and referral to pain specialists—no statistically significant specialty-related differences were observed.
However, significant variation was identified in NSAID risk counseling ( p = 0.0023) and psychosocial screening using PHQ-9 and GAD-7 ( p = 0.00062). NSAID risk counseling was reported by 44 of 52 Family Medicine physicians (84.6%), compared with 11 of 24 Orthopedic Surgeons (45.8%), 13 of 15 Neurologists (86.7%), and 10 of 13 Neurosurgeons (76.9%). Similarly, psychosocial screening practices differed across specialties, with Orthopedic Surgeons ( n = 24) reporting lower adherence to these guideline-recommended practices than other specialties.
Conclusion:
While physicians across specialties reported consistent adherence to several core diagnostic practices in chronic spine pain care, differences in reported practices were observed in NSAID risk counseling and psychosocial assessment, particularly within orthopedic practice. These findings highlight opportunities for targeted educational interventions, strengthened multidisciplinary collaboration, and improved implementation of the biopsychosocial model in chronic spine pain management.