Beliefs, behaviours and health literacy strongly influence lower back pain

A new study led by Curtin University has found that a person’s beliefs about time off from work and bed rest, attitudes relating to physical activity, and health literacy abilities have a strong influence on disability related to lower back pain (LBP).

The findings of this study were recently published in the prestigious international journal PAIN.

Lead investigator, Dr Andrew Briggs from the Curtin Health Innovation Research Institute and Curtin’s School of Physiotherapy, said the study measured health literacy, commonly defined as a person’s ability to seek, understand and use health information, and its association with beliefs about back pain and disability related to back pain.

"Currently there is a fair amount of knowledge about the factors that are associated with persistence of LBP, yet interventions only deliver modest benefits to patients," Dr Briggs said.

"There are many biological, psychological and social factors that may explain persistence of pain and disability from LBP, but health literacy has not been investigated before and this may be an important issue to consider."

This study measured health literacy with a standard instrument and also through in-depth interviews with participants to explore abilities in seeking, understanding and utilising information related to LBP.

Results from the standard instrument suggested that all participants had adequate health literacy, but information obtained from the interviews showed a different picture.

"The in-depth interviews with individuals experiencing back pain highlighted difficulties in their abilities to seek, understand and use information about low back pain, such as knowing where to access LBP resources in the community and understanding information provided by their health professional," Dr Briggs said.

"These abilities in seeking, understanding and utilising low back pain information had a strong influence on the amount of disability they experienced, even more than pain intensity."

Participants with low back pain were divided into two groups – one with high disability and the other with low disability.

"Participants with high disability were found to have poorer back pain beliefs, thinking that pain was best managed by decreased physical activity, time off work and bed rest," Dr Briggs said.

"They also had increased fear avoidance behaviours relating to physical activity and adopted a more passive coping style.

"Participants with high disability were also less optimistic about their potential for recovery. They reported that medication for pain relief was important for the effective management of their condition despite no difference in pain severity to the low disability participants."

Another important finding was that the high disability participants tended to attribute their pain to a physiologic reason (like a slipped disc), which was not the case with the low disability group.

"Although physiologic reasons may be important in some cases of LBP, international data and guidelines highlight the importance of psychological and social factors as well," Dr Briggs said.

"The fact that participants in the high disability LBP group believed that physiologic factors were the primary reason for their pain experience and did not believe the potential role of activity in their recovery demonstrates that a patient’s belief system and information provided to patients are critically important in the management of LBP."

(Source: Curtin University of Technology: PAIN: July 2010)