Blog | Tuesday, November 19, 2013

QD: News Every Day--Careful what you say about low back pain

Doctors can have a long-lasting impact on how patients perceive their low back pain, according to a study that concluded even an off-hand comment can have a lasting effect.

Researchers in New Zealand interviewed 12 people with acute low back pain of less than 6 weeks and 11 participants with chronic low back pain for more than 3 months. The patients had varied histories of low back pain, diverse exposure to health care professionals, and wide-ranging disability levels and fear avoidance beliefs.

Results appeared in the Annals of Family Medicine.

All participants with chronic low back pain and 9 of 11 participants with acute low back pain made one or more specific connections between something their clinician had said and their subsequent behavior, often coming away with a belief that they had to protect their backs from further strain.

Participants reported that their clinicians told them to adopt certain postures and strengthen specific muscles to manage their low back pain, which reinforced their belief that their spine was vulnerable. They tried to limit movement, reduce spinal load, maintain structural alignment and prevent injury, focusing constantly upon their backs even though trying to do so actually can lead to poorer outcomes and to lower expectations for recovery.

“Such information and advice could continue to influence the beliefs of patients for many years,” the researchers noted.

“Our findings show that clinicians can contribute to avoidance beliefs directly by focusing upon what patients should not do and indirectly by providing management advice and pathoanatomic explanations, which are interpreted as meaning the spine is vulnerable and requires protection,” the researchers wrote. “Nearly all participants reported receiving pathoanatomic explanations for the cause of their back pain, despite guideline recommendations against doing so. Such explanations may be provided to justify self-management recommendations; however, they influence not only evaluation of current symptoms but also appraisal of future episodes.”