Myths may worsen low back pain and promote ineffective treatments

Common myths about low back pain could lead to more pain, ineffective care and unwarranted anxiety, researchers say.

Low back pain is the world’s leading cause of disability, and it’s often associated with costly care that can sometimes be harmful, Peter O’Sullivan and colleagues write in an editorial in the British Journal of Sports Medicine.

Myths about back pain are common and can be reinforced by the media and well-meaning clinicians, the authors note.

This misinformation “can lead people to fear back pain, respond to it in unhelpful ways and drive poor healthcare,” O’Sullivan said in an email. “Myths often cause negative emotional responses such as fear, distress and loss of hope,” he added, as well as behaviors like over-protecting the back and avoiding movement, activity and work.

O’Sullivan, a specialist physiotherapist with the School of Physiotherapy and Exercise Science at Curtin University in Perth, Australia, told Reuters Health that almost daily, he comes across patients who hold unhelpful beliefs.

In their editorial, O’Sullivan and his colleagues identify 10 common myths about low back pain, and counter each of them with back pain facts that are supported by evidence.

Among the myths are the idea that low back pain will become persistent and will worsen with age, that pain is always a sign of tissue damage and requires rest, and that scans and invasive procedures are always needed to diagnose and treat low back pain.

In fact, the authors write, the evidence says persistent back pain can be scary, but it’s rarely dangerous or life-threatening and it’s unlikely to leave you in a wheelchair.

Getting older is not a cause of back pain, they add, and evidence-based treatments can help at any age. Persistent low back pain is rarely related to tissue damage and scans rarely show the cause of back pain.

Low back pain is not caused by poor posture while sitting, standing and bending, and it’s also not caused by weak core muscles. Injections, surgery and strong drugs usually aren’t effective for persistent back pain in the long term. Finding low-risk ways to control pain is key.

Dr. Houman Danesh, director of Integrative Pain Management at the Icahn School of Medicine at Mount Sinai in New York City, said it’s common in his experience, too, to find patients holding beliefs like those in the list of myths.

“I usually have to spend a portion of my office visit untangling them, the most common being patients who say they have a herniated disc from 20 years ago and have chronic back pain. That is a rare occurrence,” Danesh, who was not involved in the editorial, told Reuters Health in an email.

“It is sad and frustrating when patients take on a false identity based on a myth and lose a large part of their quality of life.”

Danesh disagreed, however, with some of the authors’ advice. For instance, there are cases when strong medications, injections or surgery can be used to treat low back pain, so that “is not entirely a myth,” he said.

“There are times these treatments are necessary, and a medical evaluation is needed to determine the best course of treatment.”

O’Sullivan said research into understanding back pain has increased, but societal beliefs and clinical practice were slow to catch up.

“Clinicians and doctors must spend time to ask patients what they understand about their back pain - its cause, consequences and how best to care for it - and then provide practical ways to manage it,” he said.