Effect of diagnostic labelling on management intentions for non-specific low back pain: a randomised scenario-based experiment

Review written by Dr Jarod Hall info

Key Points

  1. Almost 75% of primary contact clinicians think it is possible to identify the source in all cases of low back pain (LBP) and believe that pathoanatomic labeling is a more appropriate guide for diagnosis and guiding treatment choice.
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BACKGROUND & OBJECTIVE

Low back pain (LBP) is the leading cause of years lived with disability worldwide, and it is the second most common symptom-related reason for seeking care from a primary care provider (1,2). In 2016, in the United States, an estimated $134.5 billion was spent on health services for patients with low back and neck pain, and this spending appears to be consistently and rapidly increasing each year.

The vast majority of LBP (roughly 90-95%) is referred to as “non-specific LBP”. Per LBP clinical practice guidelines, the term non-specific LBP refers to LBP where it is currently not possible to identify a specific structural cause (e.g. radiculopathy, fracture, malignancy) (3).

However, the use of the term “non-specific LBP” has given rise to much criticism. Opponents of the non-specific label claim it is cumbersome to use with patients, conveys that the clinician does not know what is wrong with the patient, provides no pathoanatomical basis for LBP, and is a barrier to the provision of individualized care.

The authors of this study aimed to propose why the use of highly specific and anatomical-based specific structural labels may also be considered problematic.

In 2016, in the United States, an estimated $134.5 billion was spent on health services for patients with low back and neck pain.
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Removing labels like degeneration from LBP presentations may play a very low risk, high reward role in helping to shift patients’ perspectives.

METHODS

This study was a six-arm, parallel group, superiority randomized experiment with blinded participants conducted online.

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