July 8, 2010 -- Most adults experience back pain at some point in their lives, but for about one in 10 sufferers the condition is persistent and disabling.
It has long been recognized that patients' attitudes and beliefs about their back pain can play a big part in how well their pain is managed. Now new research confirms a patient's level of knowledge about the condition is also critical, as well as their willingness and ability to use that knowledge.
Researchers in Australia examined patients' ability to find, understand, and use the health information they were given about their back pain, a concept known as health literacy.
A high level of health literacy has been linked to better outcomes in patients with diabetes, rheumatoid arthritis, asthma, and other chronic diseases. But health literacy has not been previously studied in back pain patients, says study researcher Andrew M. Briggs, PhD, of Perth, Australia's Curtin University of Technology.
He tells WebMD that for the vast majority of patients with persistent and disabling back pain, physical factors are not the only contributors to pain perception and management.
"For most patients, psychological factors as well as beliefs, attitudes, and health literacy will also come into play," he says. "We can tell patients to stay active, for example, but if they don't believe exercise will help or if they fear activity will make their condition worse, they aren't going to do it."
Attitudes and Beliefs Affect Back Pain
The study included 56 people with chronic low back pain who characterized their condition as either highly disabling or not very disabling, as well as 61 people without back pain. All the participants were recruited from a middle class neighborhood in western Australia.
Patients were asked about the severity of their back pain and how much it affected their daily lives. They were also asked about their beliefs about back pain, their ability to cope with their pain, and other questions designed to determine their health literacy.
The surveys revealed that patients who reported being highly disabled by their back pain were more likely to believe there was a specific physical or anatomic reason for their pain.
They were also less likely to believe that their back pain would get better with treatment.
"We know from the literature that anatomical causes account for only a small proportion of back pain cases," Briggs says.
Patients who reported being disabled by their back pain had more fear that resuming normal activities or exercising would make their condition worse.
Many patients had trouble finding, understanding, or using the information they received about their condition. This was more common among patients with disabling back pain when the researchers used their own assessment of health literacy.
The study appears this week in the journal Pain.
Back Pain Patients Need to Stay Active
The vast majority of people who experience low back pain get better on their own within a few weeks.
While bed rest was once encouraged, the conventional wisdom these days is that most patients with back pain should remain as active as possible.
Orthopaedic surgeon William A. Abdu, MD, says he is not surprised that patients who don't understand or accept the importance of staying active report more disabling pain.
Abdu is medical director of the Spine Center at the Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
A study of patients with back pain now under way at Dartmouth confirms the importance of educating patients about their back pain and potential treatments, he says.
"We've found that shared decision making is critical," he says. "The idea is to educate patients as thoroughly as possible so that they can make informed choices about treatment. One might choose acupuncture while another might choose physical therapy, and another might want chiropractic care. When patients understand their options, outcomes tend to be better."
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