Biopsychosocial Approach to the Assessment of Low Back Pain
Dr Chris Barker, is a general practitioner with a special interest in pain and Associate Specialist in Pain Medicine, Merseyside. He is an honorary lecturer at Cardiff University and is a key opinion leader in primary care pain management. In the first of a series of three consultations, Chris encounters with a typical patient with low back pain.
The patient attends three weeks into pain problem. The objective is to adopt a patient centred approach to assessing and treating Low Back Pain.
The patient attended and immediately did some of the work for Chris – he began by discussing how the pain was affecting his day-today life. In a biomedical assessment it is tempting to cut straight to the chase & ignore this aspect. Chris let him continue, proving useful and helped inform some the latter parts of the consultation. As in the paediatric consultation, the information may be random in terms of how it is acquired, but must be ordered in how it is assimilated.
The next important part was to establish there were no red flags – this again helps to give a footing of security in the consultation. Chris then knew that the chances of anything sinister being missed were very low.
The examination did not reveal any unusual signs other than what would be expected in mechanical LBP.
Chris didn’t explore his thoughts on what his pain was due to. This in fact caused problems later as he clearly wasn’t reassured and requested a scan. The reason the scan discussion took the time it did was probably related to this fact. As Chris eluded to in his commentary, he would expect him back in the near future as I felt he wasn’t as reassured as he could have been.
Things that went well
- Allowed time for BPS assessment in a patient centred format
- Established that there were no Red Flags
- Understood impact for him on a personal level
- Tried to offer reassurance
- Gave diagnosis
- Shared advice about how best to manage problem
- Gave option of returning if the problem didn’t settle & what to look for
Things that could have gone better
- Could have been more focused
- Appeared hesitant sometimes which may be interpreted by patient as under-confidence.