Does Awareness of Key Reassuring Messages Influence Patient Outcomes in Participants With Chronic Low Back Pain? Secondary Analysis of an Observational Study in Primary Care

Background:   Reassurance is recommended in the management of chronic low back pain (CLBP). Reassuring messages include that serious pathology has been excluded and movement is safe. The impact of patient awareness of reassuring messages on patient outcomes has not been investigated. We aimed to describe the characteristics of people reporting awareness of reassuring messages after a 3 month education and exercise program for CLBP and to determine if awareness of reassuring messages at 3 months influences patient outcomes at 6 months.

Methods:   We performed a secondary analysis of 3850 adults who received a structured group-based education and exercise program for CLBP. Expert knowledge was used to construct directed acyclic graphs to identify relevant confounders. We used linear mixed models, adjusted for the identified confounders, to determine associations between self-reported awareness of reassuring messages at 3 months and patient outcomes at 6 months (pain, disability, fear-avoidance and self-efficacy), and to determine associations between baseline patient characteristics and awareness of reassuring messages at 3 months.

There are more articles like this @

LOW BACK PAIN Section

Results:   More awareness of reassuring messages at 3 months positively influenced pain intensity (regression coefficients; 95% confidence interval: -0.27; -0.39, -0.14), disability (-1.01; -1.58, -0.44), and fear-avoidance (-0.85; -1.13, -0.57) at 6 months. Less threatening illness perceptions and higher levels of self-efficacy at baseline were associated with more awareness of reassuring messages at 3 months; whereas being older, male, having more leg pain, and higher fear-avoidance were associated with less awareness of reassuring messages at 3 months.

Conclusions:   While effects were small, awareness of reassuring messages positively influenced patient outcomes at 6 months.

Significance statement:   Our study is the first to examine whether patient awareness of reassuring messages influences patient outcomes in chronic low back pain. We found that more awareness of reassuring messages after a group education and exercise intervention reduced pain intensity, disability and fear-avoidance. While effects were small, awareness of reassuring messages positively influenced patient outcomes. Clinicians should consider the benefits of delivering key reassuring messages as part of multi-modal low back pain management.

From the FULL TEXT Article:

Introduction

Low back pain (LBP) is a highly prevalent condition, in 2020, LBP affected approximately 619 million people worldwide (Ferreira et al. 2023). While most people recover from an episode of LBP within 6 weeks, approximately 70% of people experience a recurrence within 12 months and up to 30% develop chronic low back pain (CLBP) (de Campos et al. 2023; Traeger et al. 2016). The 2024 World Health Organisation (WHO) guidelines recommend education and exercise therapy be used for the non-surgical management of CLBP (World Health Organisation 2023). Patient education is used to improve an individual’s understanding of chronic pain, the contributing biopsychosocial factors, and to support them in developing strategies for self-management. Education may include providing a person with knowledge about diagnosis, help them make sense of their pain, dispel false/unhelpful beliefs such as risks associated with movement, assist with self-management strategies and pain-coping, and manage their expectations of recovery (Furlong et al. 2022; Moseley 2019; O’Sullivan et al. 2018). Exercise can improve function and reinforce reassuring messages by providing experiential reassurance about the safety of movement (Young, French, et al. 2025).

A person’s beliefs about pain can contribute to their back pain outcomes (Corrêa et al. 2022; Elfering et al. 2009; Grøn et al. 2019), and education is a mechanism to improve these beliefs (Buchbinder et al. 2001; George et al. 2009). Positive beliefs about back pain are associated with reductions in pain intensity (Grøn et al. 2019), compared to people who have more negative back pain beliefs, who experience delayed recovery (Elfering et al. 2009). As such, interventions that improve beliefs about pain would likely improve patient outcomes.

Despite beliefs about pain being (1) positively impacted by education and (2) associated with improved patient pain outcomes, patient education interventions have shown mixed effects on low back pain outcomes. For people with LBP, patient education has been shown in individual studies to reduce patient disability (Jenkins et al. 2025; Piano et al. 2025; Traeger et al. 2019), healthcare utilisation (Traeger et al. 2019), and fear (Traeger et al. 2015) and has favourable effects on return to work outcomes (Engers et al. 2008; Piano et al. 2022). However, systematic reviews investigating the effects of patient education have conflicting conclusions (Engers et al. 2008; Furlong et al. 2022; Jones et al. 2021; Piano et al. 2022, 2025). These contrasting conclusions likely arise from differences in the content, mode of delivery, duration and provider delivering the education, which in turn may provide a person with awareness of key educational messages to differing extents.

A person’s awareness of key educational messages may be an important factor in determining a person’s back pain outcomes after a course of education; however, data about peoples’ awareness of reassuring educational messages are rarely collected in trials. GLA:D Back is a structured education and exercise program for people with CLBP. The key messages delivered as part of GLA:D Back include: the back is made for movement, the back is strong, the brain can turn pain up and down, pain is an alarm and does not equal harm, ‘bad’ posture is common, movements inhibit pain, exercise strengthens the back and action comes before improvement (Kjaer et al. 2018; Kongsted, Hartvigsen, et al. 2019). Such educational messages have been shown to be reassuring for people with back pain (Traeger et al. 2019) and will be referred to herein as ‘key reassuring messages’.

Read the rest of this Full Text article now!