Markus Melloh.
If your lower-back pain is making you feel helpless,
convinced any movement will land you in a wheelchair, you may
be making your condition worse.
Research to be presented today to the combined Australia and
New Zealand Orthopaedic Associations' scientific meeting in
Rotorua by orthopaedic surgeon and rheumatologist Dr Markus
Melloh suggests people's attitudes to their non-specific,
lower-back pain can be used to predict whether their pain
will progress from an acute to a persistent condition.
Dr Melloh, the spine research programme director at the
University of Otago's Centre for Musculoskeletal Outcomes
Research, said most people experienced non-specific
lower-back pain at least once in their lives.
In about 95% of cases the condition corrected itself, but a
minority went on to develop persistent lower-back pain which
had significant socioeconomic and personal costs.
In the study, patients presenting with their first episode of
acute lower-back pain were interviewed at that time and then
followed up at three, six and 12 weeks, and then at six
months. This included an assessment of their attitude to
their condition.
Dr Melloh said these patients were not those exhibiting signs
of conditions such as slipped discs which would need referral
to a specialist, but those who had non-specific pain.
While the study began with 315 patients, only 169 of these
participated over the whole time of the study.
By six months, about a third of these, 64 patients, were
classed as having a persistent condition.
Researchers found those who continued to show what is called
"maladaptive cognitions" - fear and helplessness about their
condition, movement avoidance and magnification of its
seriousness - were the most likely to develop a persistent
condition.
Some of these patients reported worse pain after six months
which was not what would usually be expected, Dr Melloh said.
The researchers found, however, that the best time to screen
patients about their thinking was not at the time of the
first consultation with the doctor.
Three weeks after the onset of the pain, their attitude could
influence the likelihood of developing a persistent
condition.
The longer the "maladaptive cognitions" about the pain went
on, the more likely the patient was to have a long-term
condition.
The study suggested therapies to address the way patients
were thinking about their condition should be considered as
early extra treatment for lower-back pain for those patients
who appeared to be at risk of developing a persistent
condition.
Dr Melloh said general practitioners had an important role to
play in this, although the "tricky thing" was that they had a
heavy workload.
- elspeth.mclean@odt.co.nz
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