Low back Pain Episodes: Words Matter

As medical providers we swear to "do no harm." So when considering the whole patient and taking into consideration the cost, overmedication, and medical harm associated with the management of low back pain, it is important for clinicians to consider the power of their diagnostic labelling words.

The study above provides evidence that the use of certain words such as "arthritis", "degeneration", and "disc bulge" when treating a patient with low back pain results in poorer patient perceptions about their condition. A patient who hears these words will likely have a lower expectation of their recovery, a higher chance of surgery and a greater perceived seriousness of their pain. Words like "lumbar sprain", "non-specific low back pain", and even simply "episode of back pain" have better patient beliefs and outcomes related to their low back pain, shifting their perspective and enabling them to feel more comfortable with accepting a non-invasive low risk medical treatment option like chiropractic rehab. Clinical guidelines recommend giving advice and reassurance to help reduce or avoid unnecessary tests and treatments for non-specific low back pain.

Consistent recommendations include:

• educating people about the nature of low back pain,
  
• reassurance that it is not a serious disease and will improve,
  
• encouragement to avoid bed rest,
  
• stay active, and
  
• return to usual activities.
  

The study found that providing reassurance does not remove the negative effects of the labels arthritis, degeneration and disc bulge. Overall, this study suggests that clinicians might consider avoiding labels like arthritis, degeneration and disc bulge. Instead, clinicians could consider using labels like an episode of back pain, lumbar sprain or non-specific LBP when communicating with patients with low back pain.

In chiropractic school we were trained ad nauseam to use incredibly specific diagnoses such as "Acute traumatic facet syndrome with associated myospasm, deep referred right leg pain and lumbar intersegmental joint dysfunction complicated by chronic degenerative hypertrophic osteoarthritis and Grade I L5/S1 spondylolisthesis." I have been a practicing physician for a while now and I whole-heartedly agree with this study. I have learned that my words greatly matter to what a patient thinks and how they believe they will progress over the course of care for their low back pain. While a working diagnosis like the one above may be beneficial knowledge to the treating clinician and could certainly impact the prognosis, it means nothing to a patient. Explaining in full medical detail to a patient what every bit of the diagnosis means to a patient could be detrimental to the success of treatment, leaving them feeling hopeless and that surgery may be inevitable.

As clinicians we must be better for our patients. They deserve it!