Assessment and Management of Low Back Pain

Chronic low back pain (cLBP) is a pervasive problem, consistently among the top 5 most common reasons for primary care visits and among the most prominent painful conditions. Although some patients with cLBP have clear pathoanatomic causes of pain, for many there is no clear association between pain and identifiable pathology of the spine or associated tissues. This medically unexplained pain is often termed “nonspecific” and happens to be the most common form of cLBP. Observers tend to react with uncertainty and confusion when confronted with a patient whose pain is not clearly medically understood. Previous research has shown that laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with cLBP may feel that their pain is being devalued and discredited. In this presentation, research addressing experiences of stigma among patients with cLBP (and other chronic pain conditions) will be reviewed. Although thorough research to-date is lacking, preliminary evidence addressing the consequences of perceived stigma on the physical and psychological well-being of patients with cLBP will be discussed. Finally, therapeutic strategies that healthcare providers can utilize to help minimize potentially stigmatizing responses to their patients’ cLBP will also be addressed. (Recorded at PAINWeek 2018)