In a recent paper published in Patient Education and Counseling, these authors looked at how a doctor’s goal lined up with the patient’s goal in the management of low back pain.
Low back pain is the leading cause for disability worldwide, with a lifetime incidence of 80%.
What the authors of the research titled: “Patient led goal setting in chronic low back pain—What goals are important to the patient and are they aligned to what we measure? ” looked at was how the goals of a doctor was different to a patient’s goals.
The use of standardized outcomes for back pain often utilizes pain scales, range of motion, especially the act of bending forward without pain. Pain scales are perhaps important to the doctor but the goals of the patient includes a return to normal activity prior to injury.
Using bending forward as an outcome for function is well off the mark for outcomes as flexion stress in the disc often promotes inflammation and granulation tissue within the disc itself. Encouraging patients to ‘touch their toes’ as an outcome misinforms the discogenic pain patient (which is large percentage of back pain patients) of the movements that indicate outcomes.
Flexion stress on the spine compresses intervertebral discs that often leads to ongoing back pain in the long run. It may provide temporary relief from facet related pain, but disc height loss is inevitable if the spine is continuously flexed in this direction.
In Patient Education and Counseling, the authors looked at what was important to patients in goal setting of chronic low back pain. What they found was a patients’ goals were idiosyncratic and were not in line with therapists goals that usually include commonly used clinical measures.
Interpretation of the research:
The quirkiness of a patient’s goal often is governed by the education a patient receives about ‘why they hurt’. Chronic pain patients often struggle with understanding their own pain generators because of the plethora of mis-information about their diagnosis and solutions related to their problems. Giving a patient the understanding of their own dynamic spinal anatomy is one of the most powerful tools a therapist, doctor, spine surgeon, or chiropractor can do to help in the management of their symptoms. Teaching them something as simple as flexion and extension and how it relates to load is at the foundation of spine education.