The educational context

Communication is at the heart of the clinical consultation and one of the essential ‘vehicles’ by which information and advice is transmitted. Maguire and Pitceathley (2002) identified a number of key tasks in communication with pain patients. They are shown in Table 23.1 in which it can be seen that education and the provision of advice is not only a major component of HCP-patient communication, but that tailoring the information and ensuring patient understanding is fundamental.

Developing an educational strategy

Reconsideration of the role of education and advice in behaviour change

The importance of beliefs and expectations as influences on patient behaviour and clinical outcome has already been highlighted, and in the modification of beliefs and expectations, education clearly has a key role. It appears to be assumed often that change in beliefs and expectations will lead inevitably to a cascade of behaviour change and improved clinical outcome. However both

Table 23.1 Common back pain myths



? Back pain means serious damage and injury

? This is not always the case: pain can occur without injury. Even when specific tissues are affected, activity and work are not precluded. Temporary discomfort is often part of recovery

? Work/activity is the cause: something must be damaged so work/activity will just make it worse

? Normal work/activity can trigger symptoms, but is unlikely to cause substantial damage. The actual condition is usually not made worse by continuing work (assuming control of significant risks). Work/activity may be difficult or uncomfortable, but that doesn't mean it is doing harm

? Medical treatment and tests are necessary

? Most people, for most episodes of LBP problems, do not seek healthcare. Tests and imaging are generally unhelpful for LBP

? Back problems must be rested

? Quite the contrary—activity leads to faster and more sustained recovery and return to work. Temporary reduction of activity may be required, but long-term rest is detrimental

? Sick leave is needed as part of the treatment

? Often sick leave is not needed-staying at work is desirable, perhaps with some temporary modifications

? No return to work/activity till 100% fit and pain free

? This is clearly unrealistic and unhelpful—many workers can and do go back to work with ongoing symptoms, and they come to no harm

Adapted from Kendall et al. (2009).

cross-sectional studies and longitudinal studies have consistently demonstrated that pain-associated disability has multiple determinants.

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