Effect of Primary Care–Based Education on Reassurance in Patients With Acute Low Back Pain

Abstract

IMPORTANCE Reassurance is a core aspect of daily medical practice, yet little is known on how it can be achieved. OBJECTIVE To determine whether patient education in primary care increases reassurance in patients with acute or subacute low back pain (LBP). DATA SOURCES Medline, EMBASE, Cochrane Central Register for Controlled Trials, and PsychINFO databases were searched to June 2014. DESIGN Systematic review and meta-analysis of randomized and nonrandomized clinical trials. STUDY SELECTION To be eligible, studies needed to be controlled trials of patient education for LBP that were delivered in primary care and measured reassurance after the intervention. Eligibility criteria were applied, and studies were selected by 2 independent authors. MAIN OUTCOMES AND MEASURES The primary outcomes were reassurance in the short and long term and health care utilization at 12 months. DATA EXTRACTION AND SYNTHESIS Data were extracted by 2 independent authors and entered into a standardized form. A random-effects meta-analysis tested the effects of patient education compared with usual care on measures of reassurance. To investigate the effect of study characteristics, we performed a preplanned subgroup analysis. Studies were stratified according to duration, content, and provider of patient education. RESULTS We included 14 trials (n = 4872) of patient education interventions. Trials assessed reassurance with questionnaires of fear, worry, anxiety, catastrophization, and health care utilization. There is moderate-to high-quality evidence that patient education increases reassurance more than usual care/control education in the short term (standardized mean difference [SMD], −0.21; 95% CI, −0.35 to −0.06) and long term (SMD, −0.15; 95% CI, −0.27 to −0.03). Interventions delivered by physicians were significantly more reassuring than those delivered by other primary care practitioners (eg, physiotherapist or nurse). There is moderate-quality evidence that patient education reduces LBP-related primary care visits more than usual care/control education (SMD, −0.14; 95% CI, −0.28 to −0.00 at a 12-month follow-up). The number needed to treat to prevent 1 LBP-related visit to primary care was 17. CONCLUSIONS AND RELEVANCE There is moderate-to high-quality evidence that patient education in primary care can provide long-term reassurance for patients with acute or subacute LBP.

Neighborhood Socioeconomic Status and Receipt of Opioid Medication for New Back Pain Diagnosis

“…To further this idea, reassurance and education regarding the transient nature of acute low back pain is an important part of treatment. 42 Level of education may play a role in the efficacy of any educational intervention, as well as the potential avoidance of deviations from treatment guidelines. Last, past opioid receipt may increase the likelihood of opioid prescription for incident back pain.…”

Relationship of Opioid Prescriptions to Physical Therapy Referral and Participation for Medicaid Patients with New-Onset Low Back Pain

“…This in itself has potential to change cost and health care use. 5,29,30 Patients receiving a radiograph at baseline or a prescription of nonopioid medications were more likely to participate in PT. Most guidelines do not recommend radiographs for new-onset LBP.…”

Prescribing wellness: comprehensive pain management outside specialist services

“…Clinicians can help patients to recognise and modify unhelpful cognitions such as catastrophising, 'black and white' thinking and beliefs that drive fear-avoidance behaviours. 15,42,43 It is critical to identify and treat depression or anxiety. 42 Treatments include encouraging the scheduling of pleasurable activities, relaxation and exercise based on pacing principles.…”