Spinal Pain Patients' Beliefs about Pain and Physiotherapy

Abstract

The lay public's medical knowledge is acquired from three sources: the lay consultation and referral service, the media, and the practitioner. Satisfaction with and continued utilization of a health care service may depend on congruence between patients' beliefs about the cause of illness and practitioners' conditions of care. The results of a recent survey indicate that the information to which patients with spinal pain had access, was inadequate for them to acquire accurate knowledge of the basis for their pain and physiotherapists' conditions of care. It is suggested that more accurate information on the mechanisms of spinal pain, volunteered by physiotherapists during the encounter, would be in the interests of the lay public and the physiotherapy profession.

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

“…Herein lies the basis for irrational withdrawal from all but essential everyday physical activity and its costly consequences 24,25,88,92–98. Inadvertently or otherwise, the belief and its consequences continue to be reinforced on a daily basis, particularly by hands-on providers of care 25…”

“…Probably one of the most widely held beliefs, and a disabling one for the lay public, is that back pain is a sign that some spinal structure has become abnormally positioned,25 and that unless corrected, the spinal column will become biomechanically unsound and unable to withstand everyday forces. Symptoms are attributed to the resulting abnormal distribution of physical stresses (ie, mechanical pain due to “displaced” joints and muscles), but can also be potentially destructive in origin (eg, a “pinched” nerve), all of which may be tinged with the nagging fear of latent danger, ie, compromise of the spinal cord 99…”

“…The critical issue with this belief is its corollary, ie, that it is possible for the symptomatic “out of place” structure to be restored to its original position by noninvasive hands-on therapy,13,25 that pain will steadily decrease, and everyday activities may be safely resumed. The latter turns out to be “best practice”, although for quite the wrong reasons.…”

“…This diagnostic hands-on perception has misled dedicated professionals, and hence the gullible lay public, for decades 13,25,42. Simplistic idiosyncratic arcane philosophies with complex therapeutic rituals evolved43–47 based around this feeling and the fact that when manually perturbed (by hands-on therapy), both the mechanical “flaw” and the patients’ symptoms frequently improve.…”

“…Nonspecific factors that may positively influence patient responses to any treatment are well known,48,49 and hands-on therapy is recognized as having substantial nonspecific powers 30,50. These will not be discussed, other than to say that they are likely to be significant with treatments that are readily acceptable to the nonmedical person, especially if heavily sold to them 4,13,25,51,52…”