Since the Lancet published its 3 part expose on the low back disability epidemic Lorimer Moseley & I have been engaged in more frequent discussions on a variety of topics affecting those of us in the trenches.
One dialogue was about my observation that on Social Media things are very polarizing.
I said to Lorimer “Do you agree online people come off as so absolute?. We all have our lenses (ie bias). As scientists we need to have doubt. Excessive certainty is a warning sign.”
Here is my summary of Lorimer’s brilliant & modest reply.
We
❇️ over-worry people
❇️ need to reassure people
❇️ think there is a huge amount of unnecessary and in fact iatrogenic care going on
Our goal is to provide a
❇️ sensible application of contemporary science
Doesn’t take such a hard line –
❇️ “This reflects I think my commitment to science and my own lack of conviction that I really understand stuff.”
❇️ Respects those speaking with passion about these things yet,
“without accepting case studies and anecdote as evidence”
❇️ “Others might have greater conviction about the generalisability of these data than I have about it, or indeed about my own stuff.”
Uncertainty is needed because
❇️ none of our approaches are finished developing yet
❇️ people relapse,
❇️ people are not ‘fixed’,
❇️ long term follow-up data are incomplete
“We clearly haven’t found a perfect treatment yet.”
The future
❇️ better long-term results if there was more good pain education involved and if every clinician they seen was better informed
❇️ THAT is the key – that every HCP actually understands contemporary pain stuff and the BPS model
❇️ If the HCP doesn’t get it, then anyone they see is at a greater risk of falling off a good trajectory than they would have been if the HCP did get it.
I will share a follow-up on Lorimer’s views on why patient education is mis-understood (even in the Lancet series) & what we can do to redress this situation.
