What is the role of brief education in the management of low back pain (LBP) and sciatica?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Behavior caused by a fear of movement is commonly observed in people with cLBP who have been warned that a "wrong movement" may cause severe pain and prolonged disability. There are no systematic reviews or meta-analyses to determine the evidence-based support for training patients to better manage fear-avoidance. Nevertheless, high-quality studies have suggested that cognitive intervention, education, and exercises that reduce pain-related fear are likely cost-effective and vital in returning patients with cLBP to engaging in low levels of physical activity, including work.

Studies have reported that fear-avoidance beliefs were reduced following exercises and brief education, suggesting the importance of this intervention as a key factor for reduction of pain-related fear. A study in patients with acute pain suggests that fear-avoidance training should be offered to those with high pain scores and fear-avoidance beliefs.

More studies are warranted to compare the cost-effectiveness of brief education, by a physician or a physical therapist (or both), with back schools. On the basis of empirical data, the authors of this article do not recommend back schools at this time, but according to at least 1 high-quality study, back schools warrant more research. The authors recommend brief education to reduce sick leave. Back books or internet discussions cannot be recommended as an alternative to other treatments. Fear-avoidance training should be incorporated into rehabilitation programs as an alternative to spinal fusion, but more research is warranted to clarify the indications and most effective components of the intervention. [278]

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