The Enduring Impact of What Clinicians Say to People With Low Back Pain
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PURPOSE: The purpose of this study was to explore the formation and impact of attitudes and beliefs among people experiencing acute and chronic low back pain. METHODS: Semistructured qualitative interviews were conducted with 12 participants with acute low back pain (less than 6 weeks' duration) and 11 participants with chronic low back pain (more than 3 months' duration) from 1 geographical region within New Zealand. Data were analyzed using an Interpretive Description framework. RESULTS: Participants' underlying beliefs about low back pain were influenced by a range of sources. Participants experiencing acute low back pain faced considerable uncertainty and consequently sought more information and understanding. Although participants searched the Internet and looked to family and friends, health care professionals had the strongest influence upon their attitudes and beliefs. Clinicians influenced their patients' understanding of the source and meaning of symptoms, as well as their prognostic expectations. Such information and advice could continue to influence the beliefs of patients for many years. Many messages from clinicians were interpreted as meaning the back needed to be protected. These messages could result in increased vigilance, worry, guilt when adherence was inadequate, or frustration when protection strategies failed. Clinicians could also provide reassurance, which increased confidence, and advice, which positively influenced the approach to movement and activity. CONCLUSIONS: Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs.
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Education about pain and the modulation of pain in the brain improves the effectiveness of physical therapy, therapy engagement, pain perception, coping skills, fear of movement and catastrophizing.
“Education about pain and the modulation of pain in the brain improves the effectiveness of physical therapy, therapy engagement, pain perception, coping skills, fear of movement and catastrophizing.43–46”
From Psychological interventions for women with persistent pelvic pain: A survey of mental health clinicians (2021) · cites this paper as [44]
The Activation and Reassurance section reports that clinicians’ advice and reassurance increased confidence and positively influenced patients’ approach to movement. The paper does not examine education about brain-based pain modulation or establish improvements in physical therapy effectiveness, therapy engagement, coping skills, or catastrophizing. Page numbers were not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCBT and ACT have good evidence for use with GAD and MDD.
“which have good evidence for use with GAD and MDD.43,44,47,48”
From Psychological interventions for women with persistent pelvic pain: A survey of mental health clinicians (2021) · cites this paper as [44]
The Introduction discusses depression as a factor associated with poor outcomes in low back pain, and Activation and Reassurance describes clinicians’ advice to people with low back pain. Neither addresses evidence for CBT or ACT in GAD or MDD. Searches for those therapies and diagnoses found no relevant passage in our copy; page numbers were not provided. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Darlow, B., Dowell, A., Baxter, G. D., Mathieson, F., Perry, M., & Dean, S.
- Affiliations
- University of Otago (NZ)
- University of Exeter (GB)
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2013-11-01
- Volume
- 11
- Issue
- 6
- Pages
- 527-534
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC3823723
- OpenAlex
- W2103633087
- Cited by
- 293
- References
- 39
- Citations by year
- 2026: 19 · 2025: 28 · 2024: 26 · 2023: 29 · 2022: 41 · 2021: 24 · 2020: 22 · 2019: 26 · 2018: 14 · 2017: 22 · 2016: 17 · 2015: 15 · 2014: 7 · 2013: 2
- FWCI
- 10.03
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- low back pain, patient beliefs, patient attitudes, clinician-patient communication, acute low back pain, chronic low back pain, provider recommendation, kinesiophobia, reassurance, uncertainty
- MeSH terms
- Adolescent, Adult, Aged, Communication, Female, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, New Zealand, Physician-Patient Relations, Low Back Pain, Qualitative Research, Young Adult, Chronic Pain, Acute Pain
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