Take Home Messages:

Patients with back pain that does not have a specific identifiable cause are more likely to believe that their problem relates to some type of damage in the spine. In turn, this group of patients is more likely to catastrophise, which may limit the effectiveness of treatment. 

Addressing pain beliefs by explaining the problem and emphasising the body's ability to repair itself can help prevent catastrophising, and promote better recovery outcomes.

Why the research matters:

A person's beliefs about their back problem strongly influence their involvement with treatment and can have a significant impact on the process of healing and recovery.  

Beliefs about back problems may predate the current injury or pain, or may be influenced by treatment received and advice from practitioners.

What the research involved:

The researchers studied two groups of patients: one with back pain from a specific condition such as ankylosing spondylitis, and the other with back pain without a specific cause, sometimes called mechanical or non-specific back pain.  The first group is sometimes called inflammatory back pain and second non inflammatory back pain.

The researchers compared the beliefs people in each group had about their back pain. 

Summary of research findings:

Compared to patients with inflammatory low back pain (patients whose back problem arose from a specific condition) patients with non-specific low back pain were more likely to:

• Believe that they had an organic injury – that is, that the pain was as a result of damage to the tissues of the body; and 
• Catastrophise – that is, feel helpless, worry that the problem would not improve, and be overly cautious with activity.

These patients related their back problem to negative concepts such as damage, illness or harm.  Catastrophising can interfere with a person's approach to exercise, which is an important component of treatment for chronic back pain. Catastrophising is strongly linked to depression.

Original research:

Beliefs About the Causes and Consequences of Pain in Patients with Chronic Inflammatory or Non Inflammatory Low Back Pain and in Pain-Free Individuals
Sloan TJ, Gupta R, Zhang W, Walsh DA
Spine 33(9): 966-72. 2008

Link to PubMed Abstract