By Lynne Terry

When it comes to managing chronic pain, patients often seek out alternative care but many don't tell their physicians, a new study found.

A survey of more than 6,000 patients treated for chronic pain at Kaiser Permanente Northwest between 2009 and 2011 found that nearly 60 percent also saw a chiropractor or acupuncturist. But more than a third treated for acupuncture and more than 40 percent who saw a chiropractor did not tell their primary care physician.

"This is really important because chronic pain is a complex condition so the care needs to be well coordinated," said Dr. Charles Elder, the lead author and a Kaiser primary care physician.

The study did not analyze outcomes. Rather, it crunched data on who sought alternative care and told their Kaiser physician.

Elder said the patients were not questioned about why they didn't notify their physician.

"I would speculate that the patient might not realize that the conversation could be of importance, or might be concerned that the physician might be hostile to alternative care," he said.

Kaiser does not have any chiropractors or acupuncturists on staff in the metro area but does have a network of outside specialists. Patients can be referred by their physician or refer themselves or they can see an alternative care practitioner on their own. The results of those visits are not automatically entered in the patient's electronic health record at Kaiser. The primary care physician has to ask or the patient has to divulge the information on their own.

But often physicians don't ask and patients don't think to talk about it, Elder said.

"From a public health standpoint, our managing of chronic pain is woefully inadequate," Elder said.

Chiropractic care has been shown to be effective for acute back and neck pain and acupuncture can work for a variety of pain symptoms, Elder said. When patients find no relief with medication, physical therapy, counseling or exercise, Elder says he might suggest alternative care. But he said he wants to know what outside care his patients are receiving.

"It is important for us as physicians to know what our patients are doing, so that we can best understand what is working, what is not working and what has or has not been tried, Elder said.

If a patient with back pain was seeing a chiropractor but was still suffering, the physician might recommend acupuncture, Elder said. Or if a patient had had success with an alternative treatment in the past, the physician might recommend it if there was a flare up.

"For us to deliver the most comprehensive and effective care to patients with chronic pain, complementary and alternative modalities like chiropractic and acupuncture need to be a part of the conversation." Elder said.