Belief reinforcement: one reason why costs for low back pain have not decreased

Abstract

Recent figures show that there has been no change in the upward trend of direct and indirect costs for the largely benign symptom of low back pain in Western societies. This is despite greater understanding and the recommendation of a much more conservative and independent approach to its management. Moreover, in recent years, several large-scale education programs that aim to bring knowledge of the public (including general practitioners) more in line with evidence-based best practice were carried out in different countries. The hope was that the information imparted would change beliefs, ie, dysfunctional patient behavior and biomedical practice on the part of clinicians. However, these programs had no influence on behavior or costs in three out of the four countries in which they were implemented. It is argued that one reason for the overall lack of success is that it is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of “hands-on” providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.

Therapeutic Neuroscience Education, Pain, Physiotherapy and the Pain Neuromatrix

“…Pain is complex and it is well established that various cognitions and beliefs impact a patient's overall pain experience (Zusman, 2013, Zimney et al, 2013. The most well documented psychosocial factors include fear-avoidance and pain catastrophization (Cleland et al, 2008c, Cleland et al, 2008b, Garcia-Campayo et al, 2009, Kovacs et al, 2011.…”

“…Conversely, it is proposed that if a perceived threat is decreased, less pain will be produced by the brain to defend.Patients believe pain and injury are synonymous and see increasing pain as a sign of increasing injury or damage (Zusman, 1998, Zusman, 2013. This belief and its reconceptualization is a fundamental cornerstone of TNE.…”

Effects of proprioceptive exercises on pain and function in chronic neck- and low back pain rehabilitation: a systematic literature review

“…The relationship of pain and changes in motor control has been shown in several studies [ 11 – 17 ] and is seen as a protective reaction of the body to limit provocation of the painful area [ 9 ]. This, in the long run, can cause further damage, exacerbate the symptoms through peripheral and central nervous system sensitization (lowering of pain threshold), and promote dysfunctional movement patterns [ 4 , 10 , 18 ]. A commonly described theory suggests that reduced afferent variability from peripheral proprioceptive receptors may cause neuromuscular deficiencies.…”

Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges

“…Patients have expectations around receiving something perceived as beneficial. Breaking an expectation by denying imaging may be unacceptable to patients or providers (Zusman ). Consumer research suggests offering an alternative to replace the broken expectation is important to patients (Santa ).…”