Patients’ And Healthcare Providers’ Perceptions On Back Pain Do Not Always Align
Low back pain is jarringly common. About one-half of all working Americans will experience related symptoms at least once every year, and roughly 31 million are affected by it at any given point in time. In essence, low back pain is just “one of those things” that we will all probably face in the eventual future if we haven’t already faced.
Dealing with low back pain can be troublesome and place a strain on everyday life. Typical movements like bending over to pick something off the ground or twisting your torso when looking to the side might suddenly give you pause and make you less mobile. This regular reminder naturally leads to frustration and often creates a shift in focus to one question: “what’s causing my pain?”
As a result, many patients with low back pain start to place a particularly strong—sometimes unhealthy—emphasis on obtaining a diagnosis. This desire may be explained by several factors, such as the assumption that the diagnosis will provide a clear explanation of what is causing the pain and what treatments will improve it, even though this is rarely true. Nonetheless, not receiving a diagnosis can lead to anger and frustration in patients who feel that they are not being heard or understood. Some healthcare providers may also experience frustration with low back pain patients who expect their problem to be “fixed” by certain interventions, regardless of how realistic these expectations are.
Healthcare providers underestimate the importance of an explanation for pain
A study was therefore conducted to evaluate the expectations of patients with low back pain and compare these expectations to the assumptions of the healthcare providers who treat them. This was a survey-based study, which administered one survey to 419 patients who were visiting a doctor for low back pain for the first time. In addition to questions about demographics and pain characteristics, this survey included 8 variables frequently related to the medical care of low back pain (eg, improvement in pain/function, explanation of what is causing the pain, diagnostic testing, medication, physical therapy, and surgery), which patients were asked to rank in terms of personal importance on a 5-point scale. A similar survey was given to 198 healthcare providers, who were asked to rank the same 8 variables in terms of their importance to patients.
Patients considered an explanation for what is causing their pain to be far more important
Results showed that both patients and healthcare providers attributed similar—and high—levels of importance to the improvement of pain and the improvement of function; however, there were also several key differences in the assessment of expectations. Patients considered an explanation for what is causing their pain to be far more important than healthcare providers believed, while patients attributed much less importance to diagnostic tests, medications, and surgery compared to healthcare providers. This suggests that healthcare providers are more driven to act by ordering tests and administering treatments for their patients, while patients appear to be more interested in receiving a diagnosis.
Unfortunately, a clear diagnosis for low back pain is not always possible, or helpful.
Approximately 70–80% of all low back pain cases do not have a specific identifiable cause and are classified instead as “non-specific back pain,” which patients could contribute to patients’ frustration because it does not explain their pain. It’s also worth noting that some apparent back pain diagnoses—like a herniated disc—may not truly be responsible for the patient’s pain, which can lead to unnecessary and unhelpful treatments being undertaken.
Nonetheless, this study shows that it is essential for healthcare providers to clearly communicate with patients and educate them on the nature of low back pain, particularly by explaining that not all pain is dangerous or a reflection of injury.
As physical therapists, we incorporate these methods into our practice, and explain to each of our patients with low back pain that a diagnosis is usually less important than they might think. Instead, we start patients on a comprehensive treatment program right away that will address their pain and functional limitations without the need for other diagnostic tests that could possibly do more harm than good.
Contact Us Today for Help
So, if you’re dealing with low back pain, we invite you to contact Bacci & Glinn Physical Therapy at 559-733-2478 (Visalia) or 559-582-1027 (Hanford) to learn more or schedule an appointment today.
