Low Back Pain Intensity Affects Response to Self-Managed Educational Messaging

Closeup side view of an early 60’s senior gentleman having some lower back pain. He’s at laying sideways on the examination table while the doctor is touching and massaging his lower back area.
Individuals with low back pain responded to educational messaging about self-management differently on the basis of pain intensity.

Attitudes toward educational messaging about low back pain (LBP) self-management was affected by severity of pain. These findings were published in the journal Pain.

Researchers from the University of New South Wales, Australia recruited study participants (complete data: n=607; incomplete data: n=49) worldwide using the Neuroscience Research Australia volunteer registry and via social media platforms. Study participants responded to a questionnaire about demographics, LBP, physical activity, attitudes towards self-management, and opinions about 10 educational messages about self-management.

Some of the educational statements included:

·   Your pain may not necessarily be related to the extent of damage in your back. Hurt does not necessarily mean harm.

·   It is not necessary to know the specific cause of your back pain in order to manage the pain effectively.

·   It is rare for low back pain to be caused by a more serious health problem.

·   Imaging is usually not needed in the majority of cases of low back pain, particularly when your pain has been present for less than 6 weeks. Talk to your doctor about this.

Study participants recruited from the registry and social media were aged mean 56.3 (standard deviation [SD], 12.9) and 44.3 (SD, 13.2) years, 41% and 33% were men, and LBP intensity was 5.6 (SD, 2.2) and 4.1 (SD, 2.1), respectively.

A total of 295 participants reported no LBP, 68 acute or subacute LBP, and 277 chronic LBP. Individuals with chronic pain were older (P <.01), had higher health literacy (P <.01), engaged in less physical activity (P <.01), and were more likely to have a cultural background (P =.03).

The cohort of individuals without pain had a positive attitude toward 6 messages, especially for statements relating to staying active and pacing.

Participants who had acute or subacute pain were consistently more positive about all statements and were the most positive for 7 out of the 10 statements. A positive effect was observed for 2 messages among the individuals with acute or subacute LBP. These messages related to diagnosis or cause of LBP and intention to self-manage.

The participants with chronic LBP were the least positive toward all statements. There was a moderate positive effect among the chronic LBP group for statements about diagnosis or cause, severity of pain, imaging, and intention to self-manage.

Across all groups, those who responded positively to messaging were more likely to engage in self-management.

This study may have included some response bias, especially in light of the fact that 28% expressed interest in health research.

The study authors found that individuals with LBP responded to educational messaging about self-management differently on the basis of pain intensity. These findings may suggest that clinicians should shift educational tactics to better target patient needs. However, additional study is needed to assess whether targeted messaging improves patient outcomes.


O’Hagan ET, Pietro FD, Treger AC, et al. What messages predict intention to self-manage low back pain? A study of attitudes towards patient education.Pain. Published online November 12, 2021. doi:10.1097/j.pain.0000000000002530