Waddell on beliefs about back pain and the influence on outcomes
Friday, January 15, 2010 at 2:58PMA study published by Thomas et al. in 1999 looked at the patterns of prevalence and incidence of new episodes of back pain over a 1-year period (Thomas et al 1999). This South Manchester Study described these figures for the adult population in three groups:
- Those who have been free of back pain for the past 12 months (62%)
- Those who have had intermittent or less disabling low back pain for the past 12 months (32%)
- Those with long-standing or serious disabling low back pain (6%)
The good news is that “the incidence of new episodes [of back pain] is balanced by the number of people who improve.” (Waddell pg 76)
To follow-up on these numbers, Gordon Waddell in his book The Back Pain Revolution suggests that “Despite popular belief, there never was an epidemic of back pain. Back pain has always been a common bodily symptom, but it is no more common today than it always has been. Rather, the evidence is of an epidemic of disability associated with ordinary backache.” (pg 87)
The information and advice given by health care professionals has a dramatic influence on beliefs about back pain. Often the effect of this interaction is negative (see blog post at http://www.backexercisedoctor.com/journal/2009/12/17/the-language-we-use-to-describe-back-issues-and-its-impact-o.html ).
People with “ordinary backache” symptoms are often told that “you have wear and tear in the spine” or “degenerative disc disease.” Dr. Waddell again in his book The Back Pain Revolution suggests that to patients “this means serious deterioration; it is irreversible and will get worse as they get older… Will I end up in a wheelchair?”
As a physician I hear this every day. I see people that come in and latch onto this idea that they have “degenerative disc disease” with a notion of having a condition akin to cancer or something rather than having an “ordinary backache” that millions of people face every day. In this disease paradigm of back pain, “Instead of patients taking responsibility and coping with their own situation, they have handed over responsibility, lost control, and now wait helplessly to be “fixed” with all the negative effects on disability and outcomes.” (Waddell pg 236)
Dr. Waddell suggests that “Treating pain and physical problems in the back is only one-half of the story. Patient’s beliefs and their ability to cope play an equally important role in the development of chronic pain and disability.” (pg 237)
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