Explanatory and diagnostic labels and perceived prognosis in chronic low back pain.

Abstract

Study design: Content analysis of patient interviews, clinic letters, and radiology reports for patients with chronic low back pain of greater than 12 months duration. Objective: To explore the language used by patients and healthcare professionals to describe low back pain and any potential effect on patient perceived prognosis. Summary of background data: Diagnostic explanations by healthcare professionals may influence patient coping and uptake of therapy by patients with chronic low back pain. Although the correlation between radiologic changes and chronic low back pain is weak, these investigations are often used by clinicians as an explanation of the underlying cause for the pain. Methods: Patients were asked about their understanding of the mechanisms underlying their pain, flares, and future outcome. Notes from these interviews were transcribed, along with correspondence from primary care physicians, orthopedic surgeons and pain physicians, and lumbar spine radiology reports for these patients. Content analysis was performed to identify and group key terms. Results: Two major categories representing the predominant themes emerging from the content analysis were "Degeneration" and "Mechanical." Degenerative terms such as "wear and tear" and "disc space loss" indicated a progressive loss of structural integrity. Examples of phrases used by patients included "deterioration […] spine is crumbling" and "collapsing […] discs wearing out." The use of degenerative terms by patients was associated with a poor perceived prognosis (P < 0.01). Degenerative and mechanical terms were more commonly used by patients when they were documented in correspondence from secondary care specialists (P = 0.03 and 0.01, respectively). Conclusion: A common language is shared between professionals and patients that may encourage unhelpful beliefs. The use of degenerative terms such as wear and tear by patients is associated with a poor perceived prognosis. The explanation of radiological findings to patients presents an opportunity to challenge unhelpful beliefs, thus facilitating uptake of active treatment strategies.