Abstract
BackgroundKnowledge of neurophysiology of pain influences healthcare providers’ attitudes and beliefs about patients with chronic low back pain which affect management choices.ObjectivesThe aim of this study was to determine the level of knowledge of pain and attitudes and beliefs towards patients with chronic low back pain among final year undergraduate students from the School of Therapeutic Sciences at the University of the Witwatersrand.MethodsThis cross-sectional study included two questionnaires – Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS) for measuring attitudes and beliefs about pain and the Neurophysiology of Pain Questionnaire (NPQ) for knowledge of pain. These were distributed to 224 students. An analysis of variance and a two-sided t tests compared data with p ≤ 0.05.ResultsThe study had a 65% response rate (n = 145), of which the majority were female students (n = 115, 79%). Overall, the mean correct NPQ score was 6.01 (± 1.98), with a significant difference among the programmes (p = 0.005). Mean NPQ scores for each programme were as follows: physiotherapy 6.97 (1.77), biokinetics 6.31 (2.43), exercise science 6.25 (2.5), pharmacy and pharmacology 5.69 (1.39), nursing 5.32 (1.39) and occupation therapy 5.21 (2.09). The mean correct scores for HC-PAIRS were 63.1 (8.9), with significantly higher scores in females than males (p = 0.04). Knowledge scores had a low inverse relationship with scores for attitudes and beliefs towards patients with chronic low back pain (r = -0.304; p = 0.0002).ConclusionThere is a deficit in knowledge of pain among final year students in the School of Therapeutic Sciences, with a low correlation with attitudes and beliefs towards patients with chronic low back pain. Therefore, improving the knowledge of pain might result in a change in these attitudes and beliefs.Clinical implicationsThe results have shown an association between knowledge of pain and attitudes and beliefs towards patients with chronic low back pain. Therefore, knowledge is one of the factors that could contribute in changing the attitudes.
Highlights
Low back pain is one of the leading causes of disability worldwide (Hoy et al 2010)
Neurophysiology of Pain Questionnaire mean scores were significantly different across programme of study (ANOVA test, p = 0.005)
There was no significant difference in Neurophysiology of Pain Questionnaire (NPQ) mean scores by age, current or past history of low back pain (Table 1)
Summary
Most cases of acute low back pain progress to chronicity when recovery takes more than 3 months. This is associated with psychosocial factors (anxiety, stress, patients’ recovery expectations, somatisation, depression and fear avoidance behaviour), brain structural changes (an increase in cortical thickness, expansion and medially shifting of homunculus) and neurochemical changes (a decrease in N-acetyl-aspartate, glutamate, glucose level, choline and myo-inositol), which lead to changes in the central mechanism of pain (Stubbs et al 2016; Zhao et al 2017). A multidisciplinary team and biopsychosocial approach are currently recommended in managing patients with chronic low back pain to gain optimal results (Luk et al 2010). Knowledge of neurophysiology of pain influences healthcare providers’ attitudes and beliefs about patients with chronic low back pain which affect management choices
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