Research Review by Dr. Shawn Thistle©

Date:

Sept. 2006

Study Title:

A population-based survey of back pain beliefs in Canada

Authors:

Gross DP et al.

Publication Information:

Spine 2006; 31(18): 2142-2145.

Summary:

This study is a population-based survey aiming to assess back pain beliefs in a sample of Canadian residents. This impressive group of authors (including familiar names such as Douglas Gross, Gordon Waddell, and Rachelle Buchbinder among others) investigated how the attitudes, beliefs, and recovery expectations of respondents compared to established scientific evidence regarding the highly prevalent condition of back pain.

Further, the survey attempted to identify prevailing coping strategies and awareness of back pain-related advertising in the media.

This project is part of a larger study which is evaluating public marketing interventions surrounding back pain.

In this study, telephone surveys were conducted with 2400 subjects (1200 from Alberta and 1200 from Saskatchewan) by a single company. The survey included questions from the Back Beliefs Questionnaire, and additional questions about age, gender, recent and lifetime history of back pain, and awareness and persuasiveness of media information about back pain.

Pertinent Results:

  • the prevalence of back pain in the survey group was similar to previously reported values - lifetime incidence 83.8% and weekly prevalence of 34.2%
  • respondents generally had a pessimistic view of back pain - most agreed that it makes everything in life worse, can eventually stop one from working, and is progressively worse with age
  • 21.7% of respondents agreed with the statement: "If you have back pain, you should rest until it gets better." (notably, patients in this group were more likely to take time off work due to back pain)
  • 57.3% of respondents agreed with the statement: "if you have back pain you should try to stay active."
  • those taking time off work with back pain were more likely to utilize passive coping strategies, such as staying in bed or seeking health care
  • it should be noted that the participation rate was only 28% (therefore to get the sample size of 2400 people over 8000 had to be called) - this may indicate that survey respondents were more likely to have suffered back pain (and therefore more willing to discuss it in a phone interview), but this effect cannot be clarified with certainty

Conclusions & Practical Application:

This study, simple in its design, provides some valuable insight into what our patients believe about back pain. Contrary to recent evidence that indicates that back pain is normally a benign, self-limiting condition, most respondents in this study projected distinctly pessimistic views about it. Most subjects believed that back pain is a serious, long-term problem which is likely to lead to long-term disability.

Previous surveys have also indicated that most patients expect health care providers to be able to provide a tissue-specific diagnosis as an exact cause of their pain, despite ample evidence of our customary inability to do this (hence the popularity, and clinical accuracy of "mechanical low back pain" as a diagnosis).

This apparent disconnect between scientific evidence and patient beliefs should be somewhat alarming, but presents a unique opportunity for manual medicine practitioners to educate our patients. This can come in the form of public marketing campaigns, or perhaps more importantly, during practitioner-patient interactions.

Back pain sufferers should be reassured, activated (simple rehab, normal activities such as walking etc.), and treated minimally for episodes of acute low back pain. Preventing patients from becoming chronic by utilizing an evidence-based approach and avoiding over-treatment can prevent excessive health care costs, work loss, and provide the best service for our patients.