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'Myths and facts' education is comparable to 'facts only' for recall of back pain information but may improve fear-avoidance beliefs: an embedded randomized trial

PainSci » bibliography » Silva et al 2022
Tags: back pain, mind, pain problems, spine

One article on PainSci cites Silva 2022: The Complete Guide to Low Back Pain

PainSci commentary on Silva 2022: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This study compared two ways of teaching patients about back pain:

  1. A debunking approach, where patients were given both six common myths and the truth. “This is the BS, and here’s the reality.”
  2. A just the facts style, with no mention of the myths. “This is how it is!”

There were no important differences in the effect of these approaches, in several dozen people. Either way, patients got the message: they remembered the facts whether they had been delivered with or without their matching myths.

A boring result? Well, it’s not exactly exciting, but these results can be taken two ways that I think are interesting to contrast:

  1. There’s no need to debunk myths.
  2. There’s no problem with debunking myths.

Debunking undoubtedly works better for some people than others. “Know your audience,” as my wife reminds me every time I stray too into conversational territory too dorky for her tastes (so about three times a day).

Many clinicians (not enough, but many) are out there tying themselves in knots trying to decide how to handle myths: to bust or not to bust? One of the most common questions I’ve gotten over the years is, “What should I do when patients express belief in a myth?” This research helps me answer that question: it just doesn’t matter much! As long as the facts are in there, that’s the main thing.

I suspect that debunking is like rhetorical seasoning: it makes education a little more interesting, but doesn’t change the nutritional value. And that’s reassuring.

The back pain myths and facts used in the study

Myth 1: A scan (X-ray, CT, or MRI) will show what is wrong.
Fact 1: Scans of people without back pain are just as likely to show bulging discs and other changes. What you see on a scan may not be the cause of pain.

Myth 2: Pain equals damage
Fact 2: Pain is not an accurate indicator of injury or damage; it is a warning signal that responds to many different things. Often the warning system becomes oversensitive and produces pain when there is no damage.

Myth 3: My lifestyle habits — like smoking or overeating — do not affect my back pain.
Fact 3: General health and lifestyle can play a direct role in how much pain a person feels. This might include diet, excess weight, smoking, exercise levels, alcohol intake, stress, sleep, and fatigue.

Myth 4: Moving will make my back worse
Fact 4: Some movements are uncomfortable when you have back pain, but moving your body, doing normal activity, and returning to work as soon as possible is good for vour back and will not cause damage

Myth 5: I should avoid exercise, especially weight training because of my back pain
Fact 5: Exercise is accepted as the best treatment for back pain. No one type of exercise is better or worse, so simply do what you enjoy and feels best! Start slowly and build up gradually.

Myth 6: Surgery will help my back pain
Fact 6: Research shows that people with back pain who have surgery do not have better results than those who have other treatment. This is because many things intluence back pain, not just bones and joints.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: To assess the effectiveness of patient education with ‘myths and facts’ versus ‘facts only’ on recall of back pain information and fear-avoidance beliefs in patients with chronic low back pain (LBP).

DESIGN: Randomized Study Within A Trial (SWAT).

METHODS: 152 participants with chronic LBP were included. Participants allocated to the ‘facts only’ group received an information sheet with six low back pain facts, whereas those allocated to the ‘myths and facts’ group received the same information sheet, with each myth refuted by its respective fact. The primary outcome was ‘correct recall’ of back pain facts, and the secondary outcome was ‘physical activity component’ of the Fear-avoidance Avoidance Beliefs Questionnaire (FABQ-pa), two weeks after the provision of the information sheet.

RESULTS: There was no evidence of a difference in the proportion of participants with correct recall between ‘myths and facts’ and ‘facts only’ groups (OR 0.98, 95% CI: 0.48, 1.99) and no significant difference in FABQ-pa mean scores between groups (-1.58, 95% CI: -3.77, 0.61). Sensitivity analyses adjusted for prognostic factors showed no difference in information recall but a larger difference in FABQ-pa score (-2.3, 95% CI: - 4.56, -0.04).

CONCLUSIONS: We found no overall difference in recall of back pain information for patients provided ‘myths and facts’ compared with ‘facts only’ and a slight reduction in fear-avoidance beliefs for physical activity using ‘myths and facts’ compared to ‘facts only’, but the meaningfulness of this result is uncertain.

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