Intended for healthcare professionals

Rapid response to:


Population based intervention to change back pain beliefs: three year follow up population survey

BMJ 2004; 328 doi: (Published 05 February 2004) Cite this as: BMJ 2004;328:321

Rapid Response:

Population based intervention to change back pain beliefs: three year follow up population survey

This is an excellent work on the topic of back pain in terms of public health affairs. Some questions remain: 1. There might be some other influence on public health believes than those evoked by the study. Since the advices: keep in action, go to work, are well-known since years, the campaign might contribute only in a minor part to the positive effects (what about any unknown compaigns of companies, employees, public media etc. during the same period?) 2. Is there still a strong relationship between changed beliefs and behavior? Is there strong evidence that changed beliefs result in continuing decreased sick leave days? There is some evidence (e.g. in terms of smoking) that beliefs change but behavior does only as long as campaigns are modern and interesting.

There might be some doubt that physicians will maintain the positive effects in public health beliefs on back pain if back pain is influenced strongly by social circumstances. Moreover back pain is not only consequence of fear avoidance but as well of fear endurance beliefs. In this case an improvement of sick leave data could result in more disability just some years later: We have to keep in mind that a change of behavior should not only necessarily mean an increased maintainance of activity and work performance but an increase of relaxation, physical stretching and biopsychosocial sensitivity as well.

Competing interests: None declared

Competing interests: No competing interests

08 February 2004
Marcus Schiltenwolf Schiltenwolf
Orthopaedic surgeon, chief: department of pain therapy
Orthopädische Universitätsklinik Heidelberg 69118 Heidelberg Schlierbacher Landstraße 200a Germany