Intensive Education Helps Back Pain Sufferers Get Back to Work

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People who suffer from short-term lower back pain might be able to return to work sooner if given an intensive individual patient education session from their health care provider, according to a new review from researchers in the Netherlands.

Health care providers often use patient education to help patients better understand back problems and what they can do about them. This can include how to stay active and return to work as soon as possible, how to cope with having back pain and how to avoid strain and reduce the risk of back pain episodes in the future.

“The main goal in the treatment of nonspecific low back pain is to stimulate the patient to remain or become more active despite the pain, in a time-contingent manner,” said lead reviewer Arno Engers, of the Radboud University Nijmegen Medical Centre. “Different interventions are advised, but the main goal in most cases is to change the orientation in the patient from a pain focus to an activity focus.”

The aim of the systematic review was to determine whether individual patient education is an effective piece in the treatment plan of lower back pain.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.

The Cochrane reviewers write that lower back pain is a common disorder that can cause a “great deal of pain,” lost activity and work absenteeism.

They analyzed 24 studies that included adults who suffered from lower back pain — both short-term and long-term (chronic). The studies used different types of patient education, including a discussion with a health care provider, a special group class, a booklet or pamphlet with written information to take home, or a video.

Some studies looked at patients having these different types of interventions along with their usual care, and other studies compared intervention patients with those receiving only their usual care and no patient education.

The reviewers found that for patients with short-term lower back pain, having a 2.5-hour individual patient education session with a health care provider was more effective in speeding up their return to work than having no patient education.

For example, after seven months, 30 percent of patients who had received at least a 2.5-hour session were still on sick leave compared with 60 percent of those who received no intervention.

It was unclear which type of patient education was most effective, but Engers and colleagues concluded that patients who suffer from chronic low back pain are less likely to benefit from any type of patient education.

Moreover, while the review found that 2.5-hour individual sessions were most effective, Engers acknowledged this length of time is not often devoted to one-on-one patient education in today’s health care environment.

“To our knowledge, general practitioners have very limited time and it is presumed will take about 10 to 15 minutes for a total consultation, patient education included,” Engers said. “An extra problem in individual patient education is that it’s often not seen as an ‘intervention’ at all, not by physical therapists, or by patients or health insurance institutes.”

Roger Chou, M.D., associate professor of medicine at Oregon Health & Science University and the director of clinical guidelines development at the American Pain Society, agreed that patient education sessions of this length are rare.

“Most of the studies of intensive educational sessions were conducted in Europe, usually in countries where there is a very different system for caring for injured workers,” Chou said. “In the U.S., I think it is very uncommon outside of a few specialized clinics to provide the kind of intensive education that the Cochrane review found effective due to time and reimbursement issues.”

Chou added that low back pain sufferers do find relief from other types of treatments.

“Most people with acute low back pain experience substantial improvement in the first few weeks,” he said. “Many of the effective treatments for acute low back pain are simple ones, like over-the-counter pain medications such as acetaminophen and ibuprofen, remaining active, and using heating pads.”

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.

Engers A, et al. Individual patient education for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1.

Source: Health Behavior News Service

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