Iatrogenic Low back Pain & Disability

A hundred years ago a farmer with acute LBP would probably reduce his/her activities for a few days and then get back to work with or without the pain. They didn’t think about seeing a doctor for an x-ray or an MRI to figure out “exactly what was wrong” with them.

There is no question that modern medicine has dramatically increased our life expectancy and survival rates after major illnesses and traumas. There is however growing concern that modern medicine may be responsible for the rising disability rates in those with LBP.

This study found that LBP beliefs among aboriginal Australians determined their levels of disability. Those who held biomedical beliefs about the cause of their chronic LBP were more likely to have higher disability scores when compared to those who did not attribute their pain to a specific anatomical vulnerability of their spine.

The patients in the study admitted that their belief in a low back structure being the cause of their pain was primarily from the results of their spinal imaging and advice from various health care providers.

The study concludes that “…disabling Chronic LBP may be at least partly iatrogenic.”

PTs & MDs must stop the need to tell patients that there is a specific vulnerable structure to blame for their back pain. By blaming specific structures, we may unknowingly be making our patients worse and increasing their disability.

Reference: Lin IB et al Disabling chronic low back pain as an iatrogenic disorder: a qualitative study in Aboriginal Australians. BMJ Open. 2013 Apr 9;3(4).