Non-biomedical needs in low back pain

This study investigated the mindset of people with low back pain (LBP), to see if those patients perceive the need for specific assistance other than the physical treatment of their condition. The reason for this slant on research into back pain is interesting.

Evidence has built up in favour of the notion that LBP is not just a physical affliction and - in line with that - treatment guidelines are have changed from a purely biomedical approach to a more inclusive biopsychosocial approach. In other words, the biopsychosocial approach considers and addresses non-physical factors (such as fear of movement or perception of who is repsonsible for recovery) as well as purely biomedical factors.

Therefore the authors of the current study wanted to examine the broader non-biomedical experiences and perceptions of people with LBP - especially in relation to what they felt they needed to help them recover. Their idea was that this information would help physiotherapists and other clinicians who manage LBP to tailor their advice about self-management and better inform their use a biopsychosocial approach.

A thorough review of the literature was conducted, incorporating data from both qualitative and quantitative studies. Essentially, any study was considered that elicited the perceived needs of people with LBP in the areas of environmental factors, social, factors, community factors, socioeconomic factors and health behaviours.

The studies were conducted in 8 countries and involved both male and female participants. The people with LBP were recruited from pain management clinics, back pain rehabilitation services, family practice clinics, rheumatology clinics, and people who were living with LBP in the community who were invited using public advertisements.

4 main areas of perceived need emerged from the included studies.

• Within the household, people with LBP report report difficulties with household duties; however, there are few data regarding their need for auxiliary devices and domestic help.
• From a financial perspective, people with LBP want financial support, but have concerns about the inefficiencies of compensation systems and the stigma associated with financial remuneration.
• With regard to the workplace, people with LBP experience pressure to return to work despite difficulties with the demands of their occupation. They want their employers to be informed about LBP and they desire workplace accommodations.
• Socially, people with LBP report feeling disconnected from social networks and want back-specific social support.

Consideration of such needs may inform physiotherapists (especially those striving to use a biopsychosocial approach) to provide more relevant and effective management. The findings could also help the wider health system, social networks and the workplace to provide more relevant and effective support.

Want to read deeper into this topic? Have a look at the free full text version of this article published in Journal of Physiotherapy!