1,2,6,8,12,13 What treatment provider factors suggest a slower recovery? Thorough physical and functional examination not performed report of findings not given emphasis on medication and passive care emphasis on pathology, disease, injury and the importance of 'high-tech' testing promotion that hurt equals harm and the recommendation of bed rest, instead of promotion of activity modification and gradual exercise.

Nonpsychological patient factors predictive of a slow recovery include duration of disability, heavy job demands, past history of frequent recurrences, and sciatica. 7Īccording to Pinchus, et al., 8 the risk of developing long-term LBP, related activity limitations (disability), and work loss arises from four main sources that interact with each other: the individual treatment provider compensation or health care system and workplace or home environment. Psychological screening via history taking has low sensitivity and predictive value for identifying distressed patients, thus formal screening of some sort, such as with a questionnaire, is recommended. Whereas 'red flags' require urgent attention, further testing and possibly specialist referral, 'yellow flags' only require a shift in the focus of care. Examples include negative coping strategies, poor self-efficacy beliefs, fear-avoidance behavior, and distress. 1-6,9,20,21 They are subjective and have a significant psychosocial predominance. 'Yellow flags' are risk factors associated with chronic pain or disability. Outcome of low back pain in general practice: a prospective study.

Source: Croft PR, Macfarlane GJ, Papageorgiou AC, Thomas E, Silman AJ. Reassurance about the safety of reactivation and warnings about the dangers of deconditioning are recommended.

It is better to advise patients that LBP tends to recur, rather than build up expectations that it can be 'fixed' or cured.

Even though patients have stopped seeking care, this does not mean they are asymptomatic or fully functional.

Did you know that 12 months after initial consultation for LBP the majority of patients have not recovered?.

This article will summarize the impact of psychosocial factors on prediction of patient prognosis, and how patients with such factors can be appropriately managed.Įpidemiologic Data Shows LBP Is More Chronic than Previously Believed He is an expert in psychosocial aspects of back and neck pain patients, and has pioneered the identification of risk factors of chronicity and preemptive reactivation treatments with a cognitive-behavioral emphasis. On May 1-3, 2003, the World Federation of Chiropractic's 7th Biennial Congress will host a preeminent European leader in musculoskeletal medicine, Professor Stephen Linton.

Pins and Needles by A.J. Thomas