Five Things Patients With Low Back Pain Need From Their Doctors

https://www.medpagetoday.com/opinion/second-opinions/114573

Hopelessness. Fear. Isolation. These are the feelings reflected in the stories we heard from people living with low back pain (LBP) who participated in two focus groups held by the Duke Clinical Research Institute These patients, members of our 300-person “Spine Squad,” volunteered to share their lived experiences with us.

Threading through the conversation was frustration with their doctors. These patients are not alone in their pain, and their experiences with physicians are not outliers.

LBP is the leading cause of years lived with disability worldwide and one of the most expensive conditions to treat. It is one of the top reasons why patients seek healthcare from both primary care physicians (PCPs), physiatrists, and spine surgeons. Most PCPs have little in their toolboxto directly address the needs of patients with LBP, but specialty care is also not the answer for many patients. Evidence supports the use of nonpharmacological (non-drug) care, including spinal manipulation, acupuncture, and exercise as first-line care. However, these treatments do not fall under the purview of PCPs or specialists, resulting in a significant disconnect between clinical practice guidelines and real-world patient care.

Neither providers nor patients are satisfied with the status quo. Doctors are frustrated because they have limited time to spend with patients, LBP is difficult to definitively diagnose, and effective medical treatments are elusive. Patients are frustrated because the treatments they try often do not work well and they feel unheard or misunderstood by the medical community.

Value-based care models emphasizing patient-centered approaches offer hope for change. In the meantime, we can improve how we approach LBP care now by focusing on these five things patients told us they need from their doctors.

To Feel Heard

“He acted like the pain was all in my head” and “All she wanted to talk about was my diabetes.”

Patients with low back pain want their concerns taken seriously, to feel that you, their provider, are listening, and that you respect their lived experience. They often feel ignored or dismissed by healthcare professionals. It is important to figure out what matters mostto the patient. Listen to their concerns and acknowledge their experiences and frustrations before talking about their other health issues, even if this means making another appointment. An empathetic, patient-centered approach will build trust.

To Understand the Cause of Their Pain

“They told me, ‘It’s just chronic pain.’ That isn’t a diagnosis. Something’s causing it, and I want to know what it is.”

Patients are searching for answers. Inherent in the biomedical model is the expectation of a diagnosis and a cure. This is one reason why PCPs order imaging — patients want proof that their pain is real and hope imaging will lead to a solution. Unfortunately, early MRIs and x-rays are rarely helpful. Ancillary findings or common conditions of aging can exacerbate fear-avoidance behavior. They can also increase the likelihood of unnecessary procedures and the transition from acute to chronic LBP. An alternative to consider is recommending several weeks of guideline-concordant non-drug care first.

Reassurance and Support

“The uncertainty of living with pain forever is worse than the pain itself.”

Chronic LBP often leads to social isolation, exacerbating other mental and emotional challenges. Patients crave reassurance that they’re not dealing with a life-threatening disease, that their pain won’t be permanent, and that they can maintain a fulfilling life despite their chronic pain. It is important to remember not only the actual words said, but also how they are said. Patients want clear information delivered in plain language with an empathetic tone. There is a difference between reassurance and casual dismissal of their lived experiences.

Access to Effective Treatment Options

“I just don’t know what to do next.”

The frustration patients feel with a casual dismissal is compounded by the often unclear treatment options presented. They want to know what treatments are most likely to help and how to access them. Good sources of information include the Lancet series on LBP and the American College of Physicians LBP guideline Providing education on first-line, non-drug treatments, along with appropriate referrals, can empower patients to take an active role in their health. This may lead to more positive outcomes as patients feel more involved in their healing process.

Care Coordination

“Doctors don’t talk to each other, so I have to piece together my own treatment plan.”

Patients can find themselves caught in a loop between their PCP and specialists. It is well known that lack of coordination in healthcare delivery can create confusion and delay effective treatment. It can also increase patient burden when patients are forced to develop their own treatment plans, navigating multiple prescriptions and sometimes conflicting physician advice without a clear sense of how everything fits together. This situation is particularly challenging for individuals with multiple chronic conditions. One solution is the use of multidisciplinary integrated pain management teams. Such teams are becoming more common and offer models for improving patient outcomes and fostering a more patient-centered approach.

We have much to gain by listening to the needs expressed by LBP patients. They remind us to pay greater attention to the power of the spoken word, offer reassurance whenever appropriate, and provide guidance on effective treatment options. We can also learn from new models of care, including multidisciplinary approaches and value-based options. While considerable work lies before us to optimize management and treatment for LBP, these initial steps can help transform the experience of those living with LBP, offering them relief from their physical symptoms and the respect they deserve.

Filed under: General Problems