Back Pain – Patient Education and Psychology



There is more to managing low back pain than X-rays and treatment. Education and handling the patients knowledge, pre-existing thoughts and building the psyche are important parts of the clinical experience with all patients. Here is a great article by some knowledgable physiotherapists on how to approach the communication piece with our patients:

  • PETER O’SULLIVAN DipPhysio, PGradDipMTh, PhD, FACP IVAN LIN BSc(Physio), MManipTher, PhD

“An approach to low back pain should involve an initial triage to screen for serious pathology, assessment for psychosocial risk, clear explanations to reduce the sense of threat, active rehabilitation and discouragement of unwarranted radiological investigation.”

Key Points

“Messages that can heal in patients with nonspecific low back pain:

Promote a biopsychosocial approach to pain

  • ‘Back pain does not mean your back is damaged – it means it is sensitised’
  • ‘Your back can be sensitised by awkward movements and postures, muscle tension, inactivity, lack of sleep, stress, worry and low mood’
  • ‘Most back pain is linked to minor sprains that can be very painful’ ‘Sleeping well, exercise, a healthy diet and cutting down on your smoking will help your back as well’
  • ‘The brain acts as an amplifier – the more you worry and think about your pain the worse it gets’

Promote resilience

  • ‘Your back is one of the strongest structures of the body’ ‘It’s very rare to do permanent damage to your back’

Encourage normal activity and movement

  • ‘Relaxed movement will help your back pain settle’
  • ‘Your back gets stronger with movement’
  • ‘Motion is lotion’
  • ‘Protecting your back and avoiding movement can make you worse’

Address concerns about imaging results and pain

  • ‘Your scan changes are normal, like grey hair’
  • ‘The pain does not mean you are doing damage – your back is sensitive’
  • ‘Movements will be painful at first – like an ankle sprain – but they will get better as you get active’

Encourage self-management

  • ‘Let’s work out a plan to help you help yourself’
  • ‘Getting back to work as you’re able, even part time at first, will help you recover’

Messages that can harm in patients with nonspecific low back pain:

Promote beliefs about structural damage/dysfunction

  • ‘You have degeneration/arthritis/disc bulge/disc disease/ a slipped disc’
  • ‘Your back is damaged’
  • ‘You have the back of a 70-year-old’ ‘It’s wear and tear’

Promote fear beyond acute phase

  • ‘You have to be careful/take it easy from now on’ ‘Your back is weak’
  • ‘You should avoid bending/lifting’

Promote a negative future outlook

  • Your back wears out as you get older’
  • ‘This will be here for the rest of your life’
  • ‘I wouldn’t be surprised if you end up in a wheelchair’

Hurt equals harm

  • ‘Stop if you feel any pain’ ‘Let pain guide you’”
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