Engaging Patients in their Own Care for Back Care: The Role of Education and Advice in the Prevention of Chronic Pain and Disability

There is a spectrum of views about the actual and potential role of education and advice in the prevention of chronic pain and disability. There is on the one hand an optimism bordering on the naïve that an essential feature of the problem of chronic low back pain (CLBP) and disability is a simple knowledge deficit (on the part of patients), the correction of which by provision of knowledge and advice will be sufficient to prevent chronic pain or disability. Then there is an opposing view that education and advice are valueless or that patients are uneducable. In attempting to find a middle way between these two extremes, we begin with a review of the evidence, viewed from a number of perspectives. In considering the role of education for patients we shall also consider the role of the healthcare professional (HCP). We shall then attempt to integrate the findings into an action plan, with suggestions for a refocusing of our educational efforts in secondary prevention in patients with recurrent or persistent pain in which our principal objective is the prevention of unnecessary disability or distress rather than the prevention of further pain per se which is unlikely to be achievable.

In n developing an analysis or our current state of knowledge we shall consider: (1) the educational process; (2) types of intervention; (3) effectiveness and sustainability; (4) influence of patient characteristics; and (5) the influence of health professionals, beliefs and treatment orientations. We shall then consider: (1) education content for LBP patients; (2) the educational context; and (3) the development of an educational strategy. Finally, we will then attempt to draw a number of conclusions.

We shall, where possible, draw specifically on education/advice in the context of LBP and other musculoskeletal conditions, in which the provision of education and advice has been examined. However, we will focus particularly on their role in tacking obstacles to recovery and optimal function in the context of secondary prevention.

Our primary focus will be on the prevention of unnecessary limitations in functioning and adverse effects on well-being rather than on the prevention of persistent pain per se. Finally, by way of introduction, we declare our own starting point, or biases. We view the provision of education and advice as a core element of clinical management; and we have attempted to be open-minded about the value of education and advice. Thus we begin with an evaluation of research findings. We suspect however that education and advice may be a necessary but not sufficient condition for producing effective behaviour change. We are mindful therefore, in the appraisal of effectiveness of educational strategies, to require consideration of the effect of knowledge in the context of overall clinical or self-directed management, rather than restrict our attention to the establishment of improved understanding of low back pain (LBP) and its effects, important though that is, in addressing obstacles to optimal function and well-being.