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Influence of diagnosis on beliefs of patients with NSLBP

How does the clinical diagnosis influence the beliefs, pain, and function in patients with chronic NSLBP?

Patients with chronic, non-specific low back pain (NSLBP) identified multiple physical factors causing their pain but did not acknowledge its multifactorial nature. Moreover, they showed low improvement expectations and believed that pain intensity, symptom duration, and activities of daily living were associated with imaging findings. Together with the value placed by patients on their clinical diagnosis, this shows a strong presence of the biomedical model in their beliefs.

Patient accounts included beliefs such as “My pain my last forever, because lumbar spondylosis has no cure.” and “For example, if I heard the phrase “scoliosis in S”, I remember that I have to avoid a number of things.”.

These accounts support the importance of a correct initial approach to patients, not generating a nocebo effect during the communication. For example, it should be stressed that imaging findings alone are not sufficient to explain the pain patients feel.

> From: Bonfim et al., Braz J Phys Ther 26 (2021) 811-818 (Epub ahead of print). All rights reserved to Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Click here for the online summary.

Expert opinion

This is a very interesting qualitative study showing an aspect which is frequently underreported in the literature: what patients think.

There is so much focus on the effect of interventions and the underlying physiological mechanisms that we often forget to even consider what the person we are treating (which is after all the most important) thinks about all this.

While the value placed on a biomedical perspective may not be entirely surprising, the blame should not be entirely directed to patients. Those beliefs have been promoted by many generations of clinicians and are unlikely to be shifted from one day to the next.

Nevertheless, we should be actively promoting this shift so that it happens as soon as possible. This should be done by listening to what patients have to say and by turning our attention to what patients can (and should) do rather than to what they can’t.

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