Doctors should give greater weight to the effects of low back pain on patients' social lives

The way that back pain is assessed and treated needs to change to take into account its impact on the social lives of sufferers, according to a new Arthritis Research UK-funded study.

A team of researchers led by Warwick Medical School found that that low back pain often leads to damaged relationships, people withdrawing from society, and becoming isolated and depressed.

Publishing their findings in the online journal BMC Musculoskeletal Disorders, they suggest that clinicians should in future give greater weight to the broader impact of low back pain – including social factors – rather than concentrating on pain and disability. This may be crucial in improving patients' experiences of health care, they add.

They also say the way that the outcome measures currently used to capture and quantify back pain need to be more relevant and to take these social factors into account.

In their review of existing research 49 papers describing 42 studies, the team found a whole range of social concerns among people with low back pain, including fear of loss of employment, not being believed that there was anything wrong with them because the pain had no apparent cause, and loss of control over their lives.

"Patients with low back pain seek diagnosis, treatment and cure, but also reassurance about lack of a cause of their pain," explained lead researcher Dr Rob Froud.

"They also want to be believed as having their experiences as someone 'doing battle' with pain validated. Some people struggle to meet social expectations and obligations – but when they do they fear their credibility of the pain and disability can be jeopardised. Others withdraw, fearful of disapproval, or unable or unwilling to meet social demands.

"Pain and disability are the most commonly measured outcomes in trials of back pain treatments, but the development of the next generation of outcomes for research and clinical use needs to take a broader perspective, with emphasis on what is important to patients."

Professor Alan Silman, medical director of Arthritis Research UK said: "Chronic back pain is one of the most significant causes of morbidity in the UK, causing pain, distress and loss of function for millions. One of the issues is its persistence over in many patients several years or even decades. This research shows that the consequence is not just in terms of the physical problems but the impact it has on people's lives and social functioning, and highlights the need to consider this as both a pressing health as well as a wider societal problem."

Low back pain is the most common form of chronic pain, with approximately 4% of the UK population taking time off work because of it, equating to around 900 million working days lost every year.

While 90% of patients who consult their GP for low back pain stop seeing their GP after three months, most still have low back pain and related disability a year later, suggesting that they feel that there is limited help is available or that further consultation would not be worthwhile.