Goal of the Study?
What effect will telling a low back pain patient that they have a disc bulge or degeneration have on them? This study was published in the European Journal of Pain 1 in which researcher sought to explore what diagnostic labelling of non-specific back pain sufferers leads to.
Why are they doing this study?
It has been thought that when a patient is labelled with a specific diagnosis that it may lead to unintended treatments that can be costly and ill-directed. Currently, the term ‘non-specific low back pain’ is encouraged to be used in clinical encounters. However, many criticize this which conveys to the patient that the clinician may not know what is going on with no logical explanation for their lower back pain problem. ‘Non-specific back pain’ has garnered much backlash, so much so that the North American Spine Society released a guideline in 2020 that rejected the use of the term non-specific low back pain as it does not assist in the clinical decision-making of the patient.
The language often used by clinicians in daily practice includes:
- disc bulge
- lumbar sprain
These are all part of a disease classification system in the International Classification of Disease. However, many use non-specific low back pain instead of those four terms because the clinical tests to diagnose them are poor with low operational validity. The argument by those that prefer non-specific low back pain is to be
- to be reasonably true with the literature with the level of evidence to be specific for most low back pain conditions
- to not cast fear in the patient with lower back pain
This study was conducted in six arms, with blinded participants online. It is classified as a randomized scenario-based scientific design. Each participant (1375) with a mean age of 41.7 yrs were given one of six diagnostic labels: ‘degeneration’, ‘disc bulge’, ‘arthritis’, ‘lumbar sprain’, ‘non-specific back pain’ and ‘episodic back pain’ The primary outcome was the belief that further imaging was warranted.
What did they find?
The participants who were labelled ‘episodic back pain’, ‘lumbar sprain’, and ‘non-specific back pain’ did not feel the need for imaging when compared to those marked with ‘arthritis’, ‘degeneration’ and ‘disc bulge ‘. These labels also led to a higher rate of recovery expectation and less need for a second opinion compared to the labelling of ‘disc bulge’, ‘degeneration’ and ‘arthritis’.
Why do these findings matter?
These findings matter because communication is very important in the trajectory of back pain care. This study demonstrated that the language clinicians use to explain a low back pain patient’s condition matters in the context of the patient’s perceived need for imaging, surgery and a second opinion.
Interestingly, in the Future Research section of the paper, the authors state:
More research will be required to explore how clinicians
can best communicate a symptom in a way that is devoid
as possible of words reflecting structural disruption, whilst
also meeting patient needs.
We at Dynamic Disc Designs hope that at some point, our 3d dynamic models will be considered in research to help in the cause to bring a realistic understanding of pathoanatomy in a non-fearful way to the patients suffering from low back pain. We also hope our modelling will assist the clinician in the decision-making of a patient’s management. Many of our customers have already shared that testament.
(Attention LBP pain researchers! Please connect with us if you are interested in using our models as part of a research study.)