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Explaining Diagnostic Labels and Perceived Prognosis in Chronic Low Back Pain Patients

Chronic back pain refers to pain that lingers for 12 weeks or more, even after the initial injury or underlying cause has been addressed. It ranks among the leading causes of medical consultations and work absenteeism. Its severity can vary, from a persistent, dull ache to a sudden, intense, or shooting pain. 

This article1 summarizes a study that was conducted to show that the way healthcare professionals communicate explanatory and diagnostic labels can significantly affect patients’ perceptions of their condition. Additionally, the article shows how communication can influence prognosis and offers hope for improvement by enhancing patients’ resilience and motivation to engage in rehabilitation programs and lifestyle modifications.

Possible Causes of Chronic Low Back Pain

Various everyday activities and habits can aggravate chronic low back pain (CLBP). Here are some common factors that can contribute to or worsen CLBP:

Poor Posture: Sitting, standing, or slouching with improper posture can strain the lower back muscles and lead to chronic pain over time.

Lifting Heavy Objects: Lifting heavy objects improperly, especially without using proper body mechanics, can strain the back muscles and cause or exacerbate CLBP.

Obesity: Carrying excess weight, especially around the abdomen, can put additional stress on the lower back, leading to chronic pain.

Psychological Factors: Stress, anxiety, and depression can contribute to the perception of pain and the development of chronic pain conditions.

Smoking: Smoking restricts blood flow to the spine and can impair the body’s ability to deliver nutrients to the discs in the back, potentially leading to degenerative changes and pain.

Patients with chronic low back pain of greater than 9 months duration are assessed at the Back Pain Unit at King’s Mill Hospital for possible entry to multidisciplinary pain management programs. In a semi-structured interview, patients are asked about their understanding of the mechanism underlying their pain, flare-ups, and future outcomes.  

To explore the terminology used by sufferers of chronic low back pain to describe their condition, and to compare this with the terms used by radiologists, general practitioners, and secondary care specialists.

How Participants Were Selected

Patients were eligible to participate in the study having met the following conditions:

  • Participated 1 one of 28 consecutive pain management programs and had been interviewed by a single clinician.
  • Patients who had their hospital case notes, containing orthopedic and pain clinic entries were eligible.
  • Patients with a referral from either the Orthopedic Department or Pain Clinic were also considered.

210 case notes were reviewed in total but only 96 were eligible to participate in the program.

Results and Findings

The outcome of the study showed that within the context of describing pain, patients tend to use specific words and phrases to describe the quality, intensity, and characteristics of their pain sensations. Some of the phrases used by the patients to describe their pain are:

  • Trapped nerve
  • Compressing
  • The discs are rubbing together

Another frequently occurring theme that was noticed was that the pain resulting from a progressive loss of structural integrity was often described as degeneration, or wear or tear.

After comparing radiology reports, and MRI reports to patients’ responses, we see that 80% of radiology reports contain degenerative terms and 96% of MRI reports contain one or more of these terms.

Examples of terms used by patients included:

  • Deterioration […] spine is crumbling and 
  • Collapsing […] discs wearing out”.

The use of terms like this is associated with a poor perceived prognosis.

 

 

Conclusion

Professionals and patients often use a shared language, which can inadvertently reinforce negative beliefs. When patients use terms like “wear and tear,” it’s linked to a less hopeful outlook. Explaining test results provides a chance to challenge these beliefs, promoting acceptance of proactive treatment approaches. At Dynamic Disc Designs we create anatomical models to help doctors and therapists do this with ease and to reduce fear avoidance.

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