Patients with acute low back pain who were advised to stay active despite the pain fared better than those who were told to adjust their activity in line with their pain.
The thesis looked at 109 patients with acute severe lowback pain. They were randomly advised in one of two ways: “stay active even though it hurts” or “adjust your activity to the pain”. They were also asked to keep a diary for seven days and to note how many steps they took each day, to what extent they could carry out their day-to-day activities and how they felt physically. They also completed a form to show whether they felt depressed or not.
In spite of having more pain, the group that was advised to be as active as possible recovered more quickly and did not feel depressed at the end of the follow-up.
“The other category, who had been advised from the very start to adjust their activity to their pain, were less mobile and felt slightly depressed compared to the patients who were active,” says Olaya-Contreras, a researcher at the Sahlgrenska Academy’s Department of Orthopaedics.
She believes that this could be because some people who are depressed and in pain experience the pain more acutely. Another explanation could be that the more acute the pain is perceived to be, the less a person wants or is able to move. This, according to Olaya-Contreras, is in line with previous research.
“I think that if you’re suffering with acute low back pain you should try to remain as active as possible and go about your daily business as well as you can. If you don’t keep moving, it’s easy to get locked into a downward spiral, as inactivity combined with pain can, in a worst case scenario, turn into long-term disability and an inability to work that, in turn, can lead to depressed mood and more pain.”
Olaya-Contreras therefore feels that the health service should introduce a routine investigation to determine the underlying psycho-social causes of patients’ back problems. This could measure the degree of perceived depression as well as anxiety and fear of movement.
“The results of the investigation and associated discussion could lead to patients taking a more active role and taking responsibility for their treatment,” says Olaya-Contreras. “I also believe that it can help patients to focus more on the positive resources they themselves have to handle the pain and master various physical movements even though it hurts.”
Low back pain affects up to 80% of people of working age at some time in their lives, though most will get better. Low back pain can be recurring, and some people will continue to suffer with some degree of pain. In 85-90% of cases the pain cannot be attributed to a specific illness or injury.
Full bibliographic informationJournal: Clin J Pain. 2011 May;27(4):330-7
Title: Cross-validation of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) for clinical use. Authors: Olaya-Contreras P, Styf J, Lundberg M, and Jansson B..