Patient Expectation Affects Back Pain Outcome

Chronic low back pain is increasingly common in the developed world. It is estimated that one quarter of those with low back pain visit their doctor for help, but most do not continue after three months, although 60 to 80 percent still have pain, even after one year.

Researchers have investigated psychological influences of back pain, trying to see if any of these factors made a difference in pain and, if so, how:

  • fear avoidance
  • catastrophizing
  • depression
  • expectations
  • belief about the future

The authors of this study investigated the perception of patients with nonspecific chronic low back pain to see if changes affected the outcome, and how illness perception affected clinical outcomes six months later.

Researchers reviewed completed questionnaires from 1591 patients at the beginning of the study and from 810 at six months. The mean age of the patients was 44 years.

Disability from low back pain was measured with the Roland and Morris Disability Questionnaire (RMDQ), which scores from zero (no disability) to 24 (total disability). Perception of back pain was measured by using the Illness Perception Questionnaire (IPQ).

The researchers found that at least three out of five participants had missed at least one day of work due to back pain; 63 percent reported back pain that was present for less than three months and 11 percent had back pain for more than three months.

There were noted differences among patients who thought they would have good clinical outcomes and those who did not. Those who had better clinical outcomes:

  • perceived less serious consequences from the back pain
  • reported fewer emotional responses, such as fear and anger
  • reported fewer symptoms that were blamed on their back pain
  • felt strongly that they had some control over what was happening

The authors conclude that these findings "have practical implications for the primary care management of patients with back pain and emphasize the need to elicit and address patients' unhelpful perceptions of their back problems."

Nadine E. Foster et al. Illness perceptions of low back pain patients in primary care: What are they, do they change and are they associated with outcome? In Pain. May 2008. Vol. 136. no. 1-2.

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