Effective Reassurance in Primary Care of Low Back Pain: What Messages From Clinicians are Most Beneficial at Early Stages of LBP?

OBJECTIVES:: Effective reassurance of patients suffering from complaints for which no clear aetiological origin is available, is one of the most important challenges in the early phases of non-specific back pain. However, there is a lack of empirical studies on the effects of reassurance and, effects shown, were small. Improvements are needed with respect to the process of physician-patient interaction and to the methods used by the physician.METHODS:: We provide a short narrative review of the literature with special reference to affective and cognitive communication, based on a systematic review of 16 studies. We further consider recent evidence in the prognosis of low back pain, the role of physical activity and sub-groups-based individual differences in pain coping, questioning the information basis of reassurance.RESULTS:: A two-process model of affective and cognitive reassurance, was supported. Recovery improved in a combination of communication of empathy with cognitive reassurance, giving concrete information and instructions. In terms of information, recent research indicate that a substantial rate of patients do not recover within the first year after onset of back pain. Further, very low and high levels of physical activity are associated with pain and disability, associated with cognitive/behavioural pain coping.DISCUSSION:: Reassurance of patients in early phases of persistent back pain might improve from affective and cognitive parts of communication and individually tailored information. Subgroup differences with respect to different prognosis, associated patterns of adaptive or maladaptive pain coping and levels of health-promoting versus harmful physical activity should be considered more carefully