Gülçin BABAOĞLU, Tolga KAPLAN, Şükriye DADALI, Ali ÇOŞTU, Erkan Yavuz AKÇABOY
Anatolian Current Medical Journal - 2026;8(3):569-575
Aims: Chronic low back pain (CLBP) remains one of the leading contributors to years lived with disability globally, and guideline-based care increasingly emphasizes non-pharmacological treatments (NPTs) as first-line management. This study aimed to characterize real-world patterns of NPT utilization before tertiary pain-clinic presentation in patients with CLBP and to examine associated treatment perceptions and barriers. Methods: This single-center, cross-sectional analytical study enrolled 150 consecutive adults with chronic low back and/or leg pain. Data were collected by pain specialists using a structured clinical form covering sociodemographic characteristics, pain characteristics, prior NPT exposure, treatment continuity, Global Perceived Effect (GPE), and barriers to care. Descriptive statistics and appropriate comparative tests were used for analysis, with statistical significance defined as p<0.05. Multivariable logistic regression was performed to identify independent predictors of NPT utilization and discontinuation. Results: Of 150 patients, 97 (64.7%) attempted at least one NPT before referral. Physical therapy was most common (81.4%), followed by exercise (41.2%) and transcutaneous electrical nerve stimulation (TENS) (34.0%). Notably, no participants reported utilization of cognitive behavioral therapy (CBT) or hypnosis. Among NPT users, 29.9% discontinued treatment prematurely; lack of perceived benefit was the most frequent reason. Mean GPE scores were similar across modalities (4.44-4.67). The most prominent barriers were low motivation and insufficient information/guidance, whereas cost was the least prominent. Multivariable logistic regression identified higher appointment access barrier scores as the only significant predictor of lower treatment discontinuation among NPT users (p=0.03). Pain duration showed a trend toward lower dropout odds (p=0.13) that did not reach statistical significance. No individual factor significantly predicted NPT utilization in the adjusted model. Conclusion: In this tertiary referral cohort, NPT exposure was frequent but often narrow in scope, insufficiently multimodal, and prone to early discontinuation. Strengthening referral pathways, patient education, and adherence support may improve implementation quality before escalation to invasive interventions.
