Theme, preference, and sub-themes	No. of endorsements	Exemplary quotation
Question 26: Reasons for most preferred (N = 247) and least preferred (N = 242) health care disciplines for managing chronic low back pain
Treatment effectiveness
Reason why most preferred
Pain relief	171	“My physiotherapist assists with the relief of the tension in my back through TENS and … appropriate back-strengthening exercises. The chiropractor (in the past) has manipulated my spine back into alignment, which relieved pressure as well. Massage therapist does provide the physical relief of the tension in my shoulders, which in turn relieves the level of pain in my lower back.” (R44)
Wellness care	22	“Yoga is something that can be done every day no matter how bad I’m feeling, and it always helps my body increase its fluidity, making it easier to move; as well, it helps build and maintain strength.” (R67)
Hands-on manual therapy	17	“These practitioners [registered massage therapist, physiotherapist, chiropractor] are physically ‘doing something’ to help. Even if the relief is short term, I find it helpful.” (R235)
Multidisciplinary/multi-modal approach	12	“Immediate relief from seeing the chiropractor combined with exercises as directed along with the massage therapy. These results are supported by the opinion of the family doctor and any meds that go along with the treatments.” (R378)
Reason why least preferred
No benefit or relief	104	“[Occupational therapist, nurse, and family doctor] are not able to do much to help and they often spend most of the appointment asking question[s] I have already answered 100s of times.” (R205)
Bad experience or side effects	23	“[I] had significant worsening effects and pain — to which the chiropractor was not receptive.” (R284)
Values and preferences	20	“[Family doctor ranks last because] I don’t like being on prescription drugs for pain if it’s not needed.” (R9)
Practitioner trust
Reason why most preferred
Familiarity	44	“My massage therapist has seen me regularly over [the] years and I trust her to give me a day or two of limited relief.” (R80)
Empathy and understanding	41	“[Chiropractor, acupuncturist, and family doctor] are the ones that actually listen to me and what I tell them. Which in turn they generally want to help and find ways to help me and not just pump me full of meds/drugs.” (R189)
Competency	28	“Orthopedic surgeon, neurosurgeon, nurse — in my experience these clinicians serve the most concrete assistance and understand the systems involved in pain more deeply and thoroughly.” (R183)
Reason why least preferred
Never seen or used	84	“The physiatrist, orthopedic surgeon and neurosurgeon are at the bottom of my list as I have never spoken with these health care providers before — this isn’t because I don’t think they would be beneficial, but that I can’t comment on their treatment for my chronic low back pain.” (R367)
Lack of empathy or understanding	45	“I find [doctors] don’t listen or blame [the pain on] other issues. I personally feel marginalized and not heard.” (R68)
Limited experience or expertise	24	“The family/clinic doctors serving in the CAF have very little knowledge and experience with chronic pain. Their focus is mainly on acute injuries, and they have even less experience with alternative therapies. The only form of treatment that they are aware of is physiotherapy.” (R118)
Accessibility of services
Reason why most preferred
Easily accessible or available	16	“My [reasons for the] top three choices are that those are the things that were available to me through the military at the time [i.e., family doctor, physiatrist, occupational therapist]. I ended up paying for massage therapy and acupuncture therapy on my own account, as the military would not reimburse.” (R253)
Reason why least preferred
Limited or no access to treatment	27	“I was NOT allowed to access RMT, acupuncture, osteopathy when serving in uniform! If I did, it would have to be done in secret and I would have had to pay out of pocket for these services.” (R118)
Question 33: Final survey comments (N = 162)
Management of LBP in the military
Poor or inadequate care	85	“The military has a bad habit of doing everything in-house, until you make it clear that those services are not going to work for your specific case … Having been sent to physiotherapy did absolutely nothing. I took Tylenol 3 [prescribed by the military doctor] like candy for quite a while in order to get through my daily, weekly, and monthly tasks at hand within the military … Since my medical release from the CAF, Veterans Affairs Canada has picked up where the military lacked.” (R253)
Limited treatment options	22	“There were a far greater number of treatment options available to me after I was medically released than there were while I was still serving. There needs to be a concerted overall effort to provide a consolidated level of health care support for military members that incorporates some non-traditional methods for treatment.” (R319)
Institutional stigma	14	“The military still has a significant issue with the stigma attached to chronic pain management. People in command positions as well as the rank-and-file view members who are dealing with chronic pain as malingerers; the term ‘MIR queens’ still is used today. Members are black listed, passed up for promotion, etc. Until attitudes change at the top of the food chain, this stigma will remain fully in place.” (R378)
Effects of chronic pain
Mechanism of chronic LBP	25	“When in recruit training, I sustained an injury. I was wearing my ruck and was on the monkey bars and fell and landed on my coccyx and from that moment onwards I had pain over the coccyx region and lower back. It stayed with me [for all] 20 years [of my military career] until I released.” (R118)
Post-release management of chronic LBP	18	“VAC provides treatments benefits; however, not enough for those that need it. VAC recognizes the disability as related to military service, yet … the paperwork is huge for practitioner and member, [and the] assessments are nerve wracking and stressful. VAC processes are unnecessary for approved disabilities, and cause Vet[eran]s stress and anxiety knowing we have to do this every year.” (R197)
Long-term impacts of chronic LBP	36	“This pain is debilitating. It has changed my life entirely and my personality. Not only can I not physically achieve as much as I used to, but my mood is severely affected as well as my weight, relationships and interests.” (R68)

R = respondent; TENS = transcutaneous electrical nerve stimulation; CAF = Canadian Armed Forces; RMT = registered massage therapy; LBP = low back pain; MIR = medical inspection room; VAC = Veterans Affairs Canada.