The Enduring Impact of What Clinicians Say to People With Low Back Pain

Dr McCluskey's letter highlights another important factor. Beliefs held by those who experience back pain and their 'significant others' may well be mutually reinforcing, so what is said to significant others by health professionals should certainly be considered. Significant others could indeed be a valuable resource to support optimal functioning and reinforce helpful beliefs and behaviours.[1]

McCluskey et al.[2] found that significant others' beliefs were influenced by their own experience of chronic illness; this may indicate that the impact of what clinicians say is not limited to the person they say it to.

1. Brooks J, McCluskey S, King N, Burton K. Illness perceptions in the context of differing work participation outcomes: exploring the influence of significant others in persistent back pain. BMC Musculoskelet Disord. 2013;14:48.

2. McCluskey S, Brooks J, King N, Burton K. The influence of 'significant others' on persistent back pain and work participation: a qualitative exploration of illness perceptions. BMC Musculoskelet Disord. 2011;12:236.

Competing interests: Author on paper being discussed

Thank you for your thoughts. I too was impressed by the similarities between our findings, and those of Lin et al.(1) It is striking that these studies, conducted entirely independently of each other, amongst very different populations, and with different qualitative methodologies, have arrived at similar conclusions.

1. Lin IB, O'Sullivan PB, Coffin JA, Mak DB, Toussaint S, Straker LM. Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians. BMJ Open. 2013;3(4).

Competing interests: Author on paper being discussed

The published article adds weight to the growing body of evidence which highlights the importance of communication in low back pain treatment, providing a valuable insight into how such communication could act as an obstacle to recovery. The article also highlights the possible influence of family and friends, or 'significant others', in this communication process. Recent research investigating the influence of significant others on recovery and return to work for individuals with persistent low back pain has shown they have similar, and in some cases even stronger beliefs than patients, possibly reinforcing unhelpful treatment expectations and continued care-seeking behaviour 1, 2, 3. It has been documented that significant others shoulder the burden of care for individuals with persistent low back pain and are key to their recovery 4. Therefore, it may be equally important to think about what is also said to the significant others of low back pain patients.

References

1. McCluskey, S., Brooks, J., King, N. & Burton, K. (2011). The influence of 'significant others' on persistent back pain and work participation: a qualitative study of illness perceptions. BMC Musculoskeletal Disorders, 12, 236.

2. Brooks, J., McCluskey, S., King, N. & Burton, K. (2013). Illness perceptions in the context of differing work participation outcomes: exploring the influence of significant others in persistent back pain. BMC Musculoskeletal Disorders, 14, 48.

3. McCluskey, S., Brooks, J., King, N. & Burton, K. (2014). Are the treatment expectations of 'significant others' psychosocial obstacles to work participation for individuals with persistent low back pain? WORK: A Journal of Prevention, Assessment & Rehabilitation - Special Issue on Work & Disability (in press).

4. Miller J, Timson D. (2004). Exploring the experiences of partners who live with a chronic back pain sufferer. Health and Social Care in the Community, 12, 34-42.

Competing interests: ?? None declared

I congratulate the authors on this important paper. These findings presented mirror those of another recent paper in Aboriginal Australians (bmjopen.bmj.com/content/3/4/e002654.full?), that supports 'the things we say' as health care practitioners may have a powerful and enduring impact on people with low back pain. As a clinician i am confronted daily with people suffering with persistent spinal pain, who have been negatively impacted by the belief that their 'worn out discs' or 'lack of core stability' is the cause of their pain, leaving them fearful, protective and disabled. Ironically as this paper highlights, research does not support that degenerate discs are predictive of future back pain, and in fact to the converse, too much trunk stability is a risk factor for future back pain. This paper is a great challenge to us as health care professionals to examine our own back pain beliefs and how we communicate them - and provide a hopeful, reassuring and evidence based narrative to our patients with low back pain.

Competing interests: ?? None declared