Take Home Messages:

Brief, face-to-face education in the management of chronic low back pain reduces sick days and aids return to work.  

Education should be provided by a health care professional.  It should include:

• Reassuring the patient that pain is not an indication of the severity of their condition;
• Encouraging positive attitudes and actions;
• Discouraging behaviour that will hamper recovery; and
• Creating realistic expectations in terms of treatment and recovery.

Why the research matters:

Long term back pain is a cause of significant socioeconomic burden and management is challenging. Finding treatment options that help people with back pain is important, to improve their quality of life, reduce disability, and reduce costs for the employee, employer and community. 

What the research involved:

The researchers searched for and summarised research on “advice and education” to assist people with long term back pain.  Treatments using “back schools”, brief education, and fear avoidance training were assessed.

• In “back schools” health professionals educate groups of people about training and exercises for the treatment of LBP.
• Brief education is also provided by a health care professional. It involves educating the patient about their condition and encouraging behaviours that will facilitate recovery. A physical examination should also be included.
• Fear avoidance training encourages return to normal activities and physical exercise.

Studies were analysed according to the three treatment options and included:

• Back schools: 7 systematic reviews, or papers that summarised research, and 8 individual studies (the studies together assessed the treatment of 1,002 patients)
• Brief education: 1 summary of research and 11 individual studies (3,357 patients)
• Fear avoidance training: 6 individual studies (380 patients)

The effectiveness of the treatment was assessed by evaluating changes in pain, disability, sick leave, recurrence, cost-effectiveness, or use of health care resources.

Summary of research findings:

Brief Education: 

Strong evidence was found that brief education in the clinical setting, including clinical examination and advice, was more effective than usual care for return to work.  This should be provided by a health care professional in a clinical setting and include a physical examination. However education provided in written form or via internet discussion was not shown to be effective for return to work.

Back Schools: 

Evidence as to the effectiveness of back schools in the management of CLBP was conflicting.  As such, the review could not recommend back schools for the management of CLBP.

Fear Avoidance Training:

There was insufficient evidence to recommend the use of fear avoidance training for return to work.  However the inclusion of fear avoidance training as part of a rehabilitation program was recommended as an alternative to surgical intervention with spinal fusion.

Original research:

Evidence-informed management of chronic low back pain with back schools, brief education, and fear-avoidance training.

Brox JI, Storheim K, Grotle M, Tveito TH, Indahl A, Eriksen HR.

Spine J. 2008 Jan-Feb;8(1):28-39. Review.

Link to PubMed abstract