Exposing and Rebutting Myths About Back Pain

The general public, health care providers, patients, governments, industry, health care institutions, and disability and social security systems still cling to outmoded views about back pain. It is no exaggeration to say that myths and misconceptions about back pain are major drivers of the colossally expensive international back pain-related disability epidemic.

Everyone in the back pain field needs to continually challenge and rebut common myths and misconceptions. And there is a need for simple educational materials and public health information that can help them do so.

The most commonly cited set of general myths about back pain, and perhaps the most influential, came from a 1998 Scientific American article by Richard A. Deyo. (See Deyo, 1998.) These myths included:

1. If you have a slipped disc, you must have surgery. Surgeons agree about exactly who should have surgery.

2. X-ray and newer imaging tests (CT and MRI scans) can always identify the cause of pain.

3. If your back hurts, you should take it easy until the pain goes away.

4. Most back pain is caused by injuries or heavy lifting.

5. Back pain is usually disabling.

6. Everyone with back pain should have a spine x-ray.

7. Bed rest is the mainstay of therapy.

The myths cited by Deyo have not only changed minds, they have also been used as tools and outcome measures in scientific studies. Norwegian researchers have used these myths to gauge beliefs about back pain among health care professionals and the general public in Norway. (See Ihlebaek and Eriksen, 2006.)

A lesser known set of myths or misconceptions about occupational back pain comes from Gordon Waddell, MD, and Kim Burton, DO, PhD. In 2004, they prepared a remarkable novella-length paper for the Department for Work and Pensions in the UK on the changing nature of rehabilitation for back pain and other common health problems. In it they presented a list of common misperceptions about back pain (and other common work-associated health problems) that affect all the major players in the back pain field.

The nine misconceptions are listed in the left hand column. One would like to see these misconceptions posted on the walls of medical facilities, factories, offices, and shops, along with those of Deyo.

References:

Deyo R, Low-back pain, Scientific American, August 1998:49-53.

Ihlebaek C and Eriksen HR, Myths and perceptions of back pain the Norwegian population, before and after the introduction of guidelines for acute back pain, Pain, 2006; 120:124-30.

Waddell G and Burton AK, Table 14: Perceptions and attitudes about common health problems and work, in Concepts of Rehabilitation for the Management of Common Health Problems, London: TSO: 2004:64.

Misconceptions Bout Back Pain

The Reality

Back pain is often caused by work.

This is false. There is a high prevalence of back pain in the general population. “Work may aggravate symptoms, but overall the causal role of physical and mental demands of work is less than that of other individual, nonoccupational and unidentified factors,” according to Waddell and Burton.

Back pain signifies biological damage or disease.

This is often not the case. There is usually no evidence of permanent biological damage or disease. Even when there is, incapacity is not the rule.

Back pain usually will be cured by medical treatment.

False. “Treatment usually does not ‘cure.’” Treatment may provide symptomatic relief or control, but does not usually cure common health problems. Symptoms are often recurrent.

Back pain is often made worse by work.

This is not usually the case. Physical or mental demands may provoke or aggravate symptoms, but usually do not cause any lasting damage. “Hurt does not mean harm.” It is important to work through this obstacle to recovery.

Back pain should be treated by rest.

False. “Activity is therapeutic, “ according to Waddell and Burton. The modern management encourages and supports continuing ordinary activities (which can include work) as normally as possible.

Back pain necessitates sickness absence.

Sickness absence is not the answer. Most workers manage to remain at work or return to work relatively quickly, even with some recurrent or persistent symptoms. Long-term sickness absence is rarely necessary.

Individuals with back pain should not return to work until they are symptom-free.

“This is unnecessary, unrealistic, and unhelpful,” the researchers point out. Work in therapeutic, and return to work is an essential part of rehabilitation.

Back pain often leads to permanent impairment.

This is untrue. There is usually no evidence of progression to significant permanent damage or impairment.

Individuals often need permanently modified work.

This misconception can be harmful. Work or workplace adjustments should be a temporary measure to accommodate reduced capacity. Modified work facilitates early return to normal duties.

Adapted from Waddell G and Burton AK, reference above. Supporting information can be found in the book.