Back Pain Beliefs and their Impact on Treatment Seeking Behaviour

Abstract

Background: Back pain is the world’s leading cause of disability, and has high associated cost. Psychosocial factors such as unhelpful, maladaptive beliefs can be instrumental in the transition from acute to chronic disabling back pain. One such maladaptive belief is that back pain is due to serious spinal pathology and therefore requires rest. Many mass media campaigns have been undertaken in an effort to impact back pain beliefs (including staying active during bouts of back pain), but only a select few campaigns have had a significant impact on health behaviours. Objectives: To determine the clinical and demographic factors associated with holding adaptive vs maladaptive beliefs about physical activity during back pain. To test if believing people should stay active with back pain is associated with often back pain is discussed with healthcare providers. Finally, to see if respondents that endorse ‘staying active with back pain’ utilize more physically active treatments compared to people endorsing maladaptive beliefs. Methods: Secondary analysis of a cross sectional survey evaluating a mass media campaign. 1979 Canadian adults were surveyed between 2014-2017. Questions included demographic and clinical factors, a 5-point Likert scale of their agreement with the statement “If you have back pain, you should stay active”, and information about their healthcare use and treatment preference. The nonparametric Kruskal-Wallis Test was used to compare respondents who endorsed the ‘stay active’ belief, to those who endorse rest. Results: Average pain rating was the only demographic/clinical factor that statistically differed based on respondents’ agreement that people should stay active with back pain (p < 0.01). Treatment preference lacked differentiation based on agreement with the stay active belief (p = 0.02). Agreement with the ‘stay active’ belief was associated with more discussions with healthcare practitioners about back pain treatment (p = 0.01). iii Implications: The link between average pain score and beliefs was small and likely not meaningful. Considering other research, some demographic/clinical factors may have been oversimplified in the analysis. Treatment preference also lacked differentiation based on agreement with the stay active belief. Further research is needed in order to clarify this relationship. This study did display that beliefs are pertinent to treatment behaviour in back pain. Other research has shown that mass media campaigns on this topic have changed beliefs but struggle to change behaviours. Rather than targeting beliefs at a population level, perhaps a better strategy would be ensuring practitioners properly address beliefs during clinical interactions. A limitation for generalizing these findings are that the majority of respondents agreed with the ‘stay active’ belief, therefore the results should be verified using objective measures.