A person with low back pain or a low back pain patient, which one do you treat?
The use of patient first language is important for multiple reasons, but one of the biggest reasons for me is that it should help guide our treatment.
If I were to treat a low back pain patient, my primary focus would be on the low back. Searching for impairments and utilizing my interventions to correct any impairment that I evaluated to be out of “normal” as a source of the pain and problems they are having. This all too common approach to treating back pain continues to be a major focus in many health care practices.
Now if I were to treat a person with low back pain, my primary focus would be on the person. The Lancet recently came out with a low back pain series. While there is no doubt that low back pain is a significant problem in our society. However, I would argue it is NOT low back pain that is the problem, but the disability and suffering that go along with persistent low back pain. Seeing that years lived with disability have increased by over 50% in the last 30 years should be alarming to everyone. (ref)
Low back pain, like all pain, is a normal human experience. Why has it lead to so much more disability in the last 30 years? Medically we have advanced significantly to understand the low back and various pathologies associated with low back pain over the past 30 years. So as the late Dr. Patrick Wall reminded us health care providers: “If we’re so good, then why are our patients so bad?”.
Could it be that we are treating low backs and not the person?
Maybe our treatment of low backs has improved, but our treatment of people with low back pain has gotten worse? The complete understanding and implementation of a biopsychosocial model is still something that some practitioners struggle with. The biology is important of the low back is important, but it is only part of a very complex interactive human that contains psychological and social perspectives that are also very important.
If you are still on the fence and do not think how we interact with people makes a difference have a look at this study. (Hat tip to #SRPrereqs) Short summary of the study: findings of the study suggest having positive beliefs change your risk factors from your genetic expression. Unless we take the suggestions from the Lancet article, as a society we will struggle with treating low back pain and more and more patients will suffer disability from it.
Are you willing to be an advocate for change? Will you start treating a person with low back pain and stop treating low back pain patients?
––– Comments
Albert V
Commented • July 13, 2018
This article aligns with the primary philosophy of treating patients as merely a culmination of symptoms. Physical therapists are not taught to implement a biopsychosocial approach to treating patients. I know a physical therapist by the name of Dr. Jacobs that uses the biopsychosocial approach in treating chronic pain. His Advanced Soft Tissue Release has been shown to be effective and is supported by multiple studies. If you're curious here's a link: https://advancedsofttissuerelease.com/research
Jessie Podolak
Commented • April 6, 2018
Kory, Thanks for the GREAT reminder to treat PEOPLE, not labels. I love this quote in particular, "Maybe our treatment of low backs has improved, but our treatment of people with low back pain has gotten worse?" I can't help but think of the "Toyota-ization of medicine" which Anna Lembke speaks about as a driver for over-prescribing opioids. When the pressure to see more people in less time in order to make more money WINS, patients lose. Thanks for keeping us on track!