Physio researchers undertook a study to find out why people have particular beliefs about low back pain and also to assess the effect of those beliefs.
They found that although the study participants use information on back pain obtained from the Internet, as well as from family and friends, they continue to trust their physicians and use them as their primary source of information and advice.
"The current study furthers understanding of how and when various sources of information contribute to beliefs, highlighting that clinicians can have a profound and long-lasting influence," the researchers write. They add that patients' expectations regarding recovery can be strongly influenced by single, perhaps off-hand statements by their physicians. "This finding is important given that low recovery expectations are a strong predictor of poor outcome," they write.
They also note that avoidance of activities because of fear of pain has been associated with poor outcome and that physicians may inadvertently contribute to avoidance beliefs and behaviors by focusing on what patients should not do rather than what they should do.
"Participants viewed lifting techniques, postural control, and muscle strengthening as strategies to protect the back," the authors note. However, they add, evidence does not support the idea that protection prevents pain.
"Our study shows that these protection strategies may result in increased vigilance, worry, frustration, and guilt for patients with low back pain," they write.
The researchers further emphasize that information communicated to patients may influence patients for years to come, so it needs to be appropriate not only for the current episode of back pain but also for any future episodes.
"Our findings also show clear activity advice and appropriate reassurance can be empowering," they write.
They conclude, "We recommend prospective studies to investigate ways of packaging information and advice that enables people to use their back freely, potentially reducing the persistence of disability."
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Ann Fam Med. 2013;527-534. Full text
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