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.