By Thomas G. Ciccone
Interview with Kathryn Schopmeyer, DPT, CPE, CSCS
Clinicians treating patients for nonspecific low back pain may want to consider how they communicate to patients about the condition. A real language barrier can exist between clinicians and patients, something clinicians may be unaware of or simply overlook, according to Kathryn Schopmeyer, DPT, CPE, CSCS, physical therapist and PT Pain Program Coordinator for the San Francisco VA Healthcare System.
Patients often interpret commonly used medical terms differently than the clinician intended.Words like “chronic,” “instability,” and “wear and tear” may be misunderstand or create a negative connotation from the way a clinician describes the condition, noted Dr. Schopmeyer during her presentation at PAINWeek.1 Instead, clinicians should focus on more positive terms when describing a patient’s spinal health, using words like “resiliency,” “adaptable,” and “protection.” In this way, the very language clinicians use can push patients into a more positive mindset about their condition, developing the self-efficacy necessary to have a higher quality of life, Dr. Schopmeyer told Practical Pain Management.
Problematic Terms in Chronic Back Pain Management
Clinicians may be surprised at how certain terms, while common vernacular to the medical community, can carry a bevy of negative misconceptions. “Nonspecific back pain” may imply the clinician cannot figure out a relevant diagnosis, is incompetent, or just wants to refer the patient to a specialist instead of helping them.2
“Chronic back pain” itself can be a problematic term that influences patient perception negatively. Patients oftentimes equate “chronic” to “incurable” or even “degenerative.” While chiropractors and osteopaths may think using the term “chronic” can reassure patients they’re going to receive long-term treatments for their pain, the term may lead patients to believe they are stuck in a static, hopeless prognosis.2
One topic prone to miscommunication is the idea of core stabilization for chronic back pain sufferers. While core stabilization exercises may help decrease disability and pain in patients,3some ill-conceived words clinicians may use to describe core stabilization could spark negative perceptions in a patient’s mind. “When we start using the word ‘instability’ with our patients, what do they think when they hear that word?” For some patients, “instability” could mean that movement could harm them at any moment, during any physical activity, or that their bodies are vulnerable to injury even if they are not, which may prompt patients to develop kinesiophobia and fear avoidance beliefs, she noted.
Researchers now know such psychological aspects, especially kinesiophobia, can influence patients to have more trunk stiffness when responding to forward perturbation.4 Since the medical community now recognizes the biopsychosocial perspective of pain management, practitioners may need to focus on how patients psychologically deal with their pain, and how this could affect the way they engage their muscles during everyday activities, Dr. Schopmeyer noted in her lecture.
“We have to stop patients from feeling like they have to tighten their stomach every time they move, or that movement is only safe if they are activating their core.” Patients may feel this way because their treatment regimen includes core stabilization exercises, prompting them to equate stiff, tense muscles with more protection for their spine, Dr. Schopmeyer noted.
This does not mean core stabilization exercises only lead to misconstrued behaviors, though. Evidence shows motor control exercises, whether alone or as a supplementary treatment, can help reduce pain and disability for patients suffering from persistent, nonspecific low back pain.2However, there is also no evidence proving an exercise program to strengthen the lower back is any better than a walk training program5, Dr. Schopmeyer said.
Dr. Schopmeyer noted that in her own practice, core strengthening can be a useful treatment for patients with chronic low back pain, although she does not advocate a blanket policy of recommending core strengthening exercises for every patient. Instead, patients should be encouraged to be more active in general, where even simply walking more regularly can provide noticeable benefits.
Individualizing therapy for each patient and addressing their posture, ergonomic workplace, and other lifestyle factors can help patients improve their problem areas. Clinicians also should be wary of how they use certain medical terms when communicating with patients. Some patients treated for chronic back pain may have familiarity with these terms, but this does not guarantee they properly understand them.3
- Schopmeyer K. The unstable argument for core stability. Presented at: PAINWeek 2016. September 6-10, 2016; Las Vegas, Nevada.
- Barker KL, Reid M, Lowe CM. Divided by a lack of common language? – a qualitative study exploring the use of language by health professionals treating back pain.BMC Musculoskelet Disord. 2009;10:123.
- Macedo LG, Maher CG, Latimer J, et al. Motor control exercise for persistent, nonspecific low back pain: A systematic review.Phys Ther. 2009;89(1):9-25.
- Schnayderman I, Katz-Leurer M. An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial.Clin Rehabil. 2013;27(3):207-214.