Acute low back pain management in general practice: uncertainty and conflicting certainties

Darlow, Ben; Dean, Sarah; Perry, Malcolm O.; Mathieson, Fiona; Baxter, G. David; Dowell, Anthony

doi:10.1093/fampra/cmu051

Cited by 33 publications

(55 citation statements)

References 46 publications

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“…The latter consideration may be particularly important to clinicians who perceive themselves as vulnerable to litigation and are challenged by the need to exclude the possibility of serious pathology within short consultation times. [13][14][15] Even in situations where the GP advises against imaging, patient expectations (along with GP perceptions of the expectations of their patients) may nonetheless lead to referral. In Australia, spinal imaging is widely available and easily organised via an abundance of private radiology companies.…”

Section: Low Back Painmentioning

confidence: 99%

Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging?

Wheeler¹,

Karran²,

Harvie³

2018

Aust J Gen Pract

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Section: Low Back Painmentioning

confidence: 99%

Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging?

Wheeler¹,

Karran²,

Harvie³

2018

Aust J Gen Pract

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“…It further stresses that also in patients with acute neck pain, the multidimensional approach of pain management should be present from the onset of treatment in order to improve outcome, which might not always be the case in daily clinical practice. In the management of acute low back pain, general practitioners were reported to understand pain as a direct representation of tissue injury, and therefore, assessment or management of attitudes and beliefs was of low priority [ 25 ]. However, it is well known that appropriate information and the patient’s understanding of pain is crucial in the treatment of acute LBP [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Importance of psychological factors for the recovery from a first episode of acute non-specific neck pain - a longitudinal observational study

2016

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BackgroundThe influence of psychological factors on acute neck pain is sparsely studied. In a secondary analysis of prospectively collected data, this study investigated how several psychological factors develop in the first three months of acute neck pain and how these factors influence self-perceived recovery.MethodsPatients were recruited in various chiropractic practices throughout Switzerland between 2010 and 2014. The follow-up telephone interviews were conducted for all patients by research assistants in the coordinating university hospital following a standardized procedure. The population of this study consisted of 103 patients (68 female; mean age = 38.3 ± 13.8 years) with a first episode of acute (<4 weeks) neck pain. Prior to the first treatment, the patients filled in the Bournemouth Questionnaire (BQ). One week and 1 and 3 months later, they completed the BQ again along with the Patient Global Impression of Change (PGIC). The temporal development (repeated measure ANOVA) of the BQ questions 4 (anxiety), 5 (depression), 6 (fear-avoidance) and 7 (pain locus of control) as well as the influence of these scores on the PGIC were investigated (binary logistic regression analyses, receiver operating curves (ROC)).ResultsAll psychological parameters showed significant reduction within the first month. The parameter ‘anxiety’ was associated with outcome at 1 and 3 months (p = 0.013, R2 = 0.40 and p = 0.039, R2 = 0.63, respectively). Baseline depression (p = 0.037, R2 = 0.21), but not baseline anxiety, was a predictor for poor outcome. A high reduction in anxiety within the first month was a significant predictor for favorable outcome after 1 month (p < 0.001; R2 = 0.57).ConclusionsPsychological factors emerged from this study as relevant in the early phase of acute neck pain. Particularly persistent anxiety and depression at baseline might be risk factors for a transition to chronic pain that should be addressed in the early management of neck pain patients.

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“…We noted an underlying assumption by patients that severe LBP mandated spinal imaging and an accompanying biomechanical explanation. Previous studies have found that such beliefs and expectations primarily arise from earlier experiences of LBP care, the influence of family and friends, and comments from previously consulted health professionals . However, most clinical guidelines recommend patients with acute LBP do not require imaging unless there are ‘red flags’ present suggesting underlying pathology .…”

Section: Discussionmentioning

confidence: 99%

The experience of patients admitted to hospital with acute low back pain: a qualitative study

et al. 2016

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We have described new patient insights which highlight how the hospital environment adds unique challenges to managing acute LBP. Several suggestions for acute LBP management guidelines are made: developing lay summaries for patients, including methods for communicating the team structure and roles to patients, and ensuring all members of treating teams are educated to ensure guidelines are consistently implemented.

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Acute low back pain management in general practice: uncertainty and conflicting certainties

Cited by 33 publications

References 46 publications

Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging?

Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging?

Importance of psychological factors for the recovery from a first episode of acute non-specific neck pain - a longitudinal observational study

The experience of patients admitted to hospital with acute low back pain: a qualitative study

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