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Back to School for Back Pain


WebMD Health News
Reviewed by Gary D. Vogin, MD

Aug. 21, 2001 -- Researchers from the Netherlands suggest that people who are battling chronic back pain may need to return to school.

Back patients may already have the reading and writing part down. But special back schools, the experts say, could be helpful by presenting a concentrated program that teaches how to manage pain and get on with life.

In their recent report, published in the Archives of Physical Medicine and Rehabilitation, the Dutch investigators showed that a back school program improves ability to do normal activities while enhancing patients' overall sense of health and diminishing their sense of being disabled.

Study author Audy Hodselmans says these patients often fear that any exertion might bring a return of that all-too-familiar (and excruciating) pain that makes the ailment such a ... pain. So while back pain itself is undeniably real, the limitations it imposes are at least partly a matter of perception, he tells WebMD.

At a back school at the Rehabilitation Center Beatrixoord, in the Netherlands, patients with chronic pain are taught to recognize and pay attention to their body's signals so that they have a better idea of what they can and can't do.

"You have to learn when you can stop and when you can go on," Hodselmans says. "We teach people to perceive when the light is green and when it is red."

In the study, 14 patients received instruction in the back school for an average of three-and a half months. Endurance, ability to function and lift things, and self-perceptions of disability were compared with 10 patients who did not receive the back school instruction.

The results: The patients in school improved significantly compared with the others. "The patients dare to go on longer and knew their physical limitations better, and they improve in physical capacity because they know how to prevent chronic overloading," Hodselmans tells WebMD.

One expert who reviewed the study for WebMD, however, cautioned that this report is based on a very small number of participants and does not measure long-term improvement. It also suffers from the same limitations that other studies on back schools do: It is very hard to know what exactly it is about back school that helps patients improve, says Steven J. Atlas, MD. Atlas is a physician at Massachusetts General Hospital and an instructor in medicine at Harvard Medical School in Boston.

The problem is compounded by the fact that back schools vary markedly in what they teach and how they teach it. Back schools exist in the U.S., sometimes as part of disability insurance plans, sometimes as freestanding clinics, and sometimes as part of a hospital.

"There are multiple things that are done," Atlas tells WebMD. "It may be very simple things such as good education about how to take care of your back, which many doctors do as part of routine practice."

Still, Atlas says there is a body of research that appears to support the effectiveness of back school instruction. So should you go back to school for your back? Atlas says people should have realistic expectations.

"I tell my patients that just because they have had pain for many years doesn't mean they are going to have it forever," Atlas says. "There are important things they can do to live with the pain. A lot of these [back school] programs help them do that. But many patients want a magic cure because they have had the pain for so long. I would love to find it for them, but it's not likely."

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