This nationally representative cross-sectional study is the largest exploration of treatment utilisation for Australian women with back pain to date. As a baseline, the study reveals the burden of back pain for mid-aged women in Australia with 77% (n = 8063) experiencing some form of back pain and 20% (n = 2044) often. The prevalence of back pain, with the associated consequences for mobility and general physical and mental health, strengthen the already well-documented identification of back pain as a major public health problem in Australia.
The study shows broadly that mid age women who consulted with a CAM practitioner have better general health, physical functioning and vitality. This finding supports those identified by Foltz et al  whose results indicate that CAM users with chronic back pain were healthier and more active than those who did not use CAM. While these women may have had better health status to begin with, they may also have been helped by CAM use providing better management of their back pain. Our analysis also reveals that those women who experienced back pain ‘often’ were less satisfied with access to general practitioners, perhaps pointing to a motivation for consulting with a CAM practitioner  (though usually only in concurrence with conventional care).
The use of CAM amongst this cohort of mid age women appears to be supplementary rather than exclusive. Most women consulted a conventional care provider but many also consulted with a CAM practitioner. The more frequent the back pain, the more likely they were to consult with a CAM practitioner as well as conventional care provider. This use of multiple practitioners reinforces findings from previous studies which have shown the use of conventional care along with CAM for the management of back pain [5, 7, 27]. The women in our study did not forgo their conventional care providers, but did concurrently use CAM practitioners. Importantly only 1.7% of women with back pain consulted with a CAM practitioner alone. As a conventional practitioner was almost always consulted by these back pain sufferers, any concerns regarding risk and CAM may be overstated, providing there is communication between patient and GP about CAM use. The increasing prevalence of CAM use, and the efficacy benefits – both evidenced and perceived – in line with the finding that the overwhelming majority of women who sought help for back pain utilised CAMs concurrently to conventional care, underlines the importance of mutual disclosure and discussion between patients and general practitioners .
Given that GPs are generally the first provider consulted for back pain care, the findings provide a timely reminder of the value of open communication with patients about their CAM use, in order to ensure agreement about therapeutic plans . Better communication is needed between patients, conventional providers and CAM practitioners to ensure the creation and maintenance of ‘best’ treatment plans for back pain sufferers. Our findings point to the relevance of future research aimed at understanding and exploring the nature of treatment utilisation, particularly whether treatments are self-administered, provided by practitioners, or self-administered with the aid of a practitioner. Moreover, they point to the importance research focused on enhancing our understandings of patient motivations and treatment utilisation for back pain and the determinants of care-seeking  as well as patient and practitioner experiences of communication about the utilisation of a range of therapies.
We acknowledge the limitations of our study, firstly in the potential effects of recall bias following the use of self reporting of health and treatment utilisation by the participants. Additionally, back pain status was defined by the self-reporting of a single question. This lack of confirmatory diagnosis could potentially bias the findings, however, existing research has evidenced the validity, and comparability to medical record assessments, of a questionnaire-based measure of comorbidity . A final limitation lies in our inability to ascertain whether the self-reported use of CAM and conventional healthcare was for back pain or some other reason(s). This limitation though is offset by the analyses of such a large, nationally representative sample of mid-age women. Moreover, our findings strongly suggest the use of individual CAM modalities for back pain care. For all CAM provider modalities consultations increased as the frequency of back pain increased, with the most utilised CAM practitioner groups (massage therapy and chiropractic) acknowledged as popular CAM therapies for back pain .