589: What do the general public believe about back pain? A scoping review

Topic: Education, Societal Impact, and Others
Subtopic: Education

Background and Aims: Misconceptions about back pain are common among the general public and may drive disability, ineffective self-management, and low-value healthcare use [1-3]. While individual beliefs (e.g., causes of back pain) have been described [4], a comprehensive overview of population-level beliefs and their measurement remains lacking. This scoping review aimed to map the prevalence, types, and assessment tools of back pain–related beliefs in population-based studies, and to identify key gaps in contemporary evidence.

Methods: Six databases were searched from inception to September 2024. Eligible studies used probabilistic sampling of the general population and quantitatively assessed the prevalence of different beliefs about back pain (e.g., natural history, mechanism, prognosis, or management). Given the significant heterogeneity of belief used to measure the same underlying constructs, belief statements were grouped into domains using a conceptual framework informed by the biopsychosocial model and current clinical guidelines. Data were synthesised descriptively. We then used broader belief domains to identify a set of ‘key beliefs’ measured in the general population.

Results: Twelve studies (22,903 participants) from high-income countries were included. Ninety belief statements were identified across nine domains. A substantial proportion of the public endorsed misconceptions, including beliefs that back pain is caused by specific injuries (47.3 to 58.5%), requires rest (20.4 to 76.5%), usually needs healthcare (53.7 to 84.8%), and benefits from imaging (44.6 to 70.6%). Endorsement of evidence-consistent beliefs was generally low and varied widely across countries, particularly regarding activity (28.9 to 86.6%) and medication use (23.9 to 32.6%). Measurement tools varied widely and showed limited coverage of contemporary guideline-based care.

Conclusions: Population-level misconceptions about back pain remain widespread and have been documented almost exclusively in high-income countries. This highlights a major evidence gap regarding public beliefs in diverse cultural and healthcare contexts, particularly in low- and middle-income countries. Existing measurement tools inadequately capture contemporary evidence on inappropriate care and appropriate healthcare-seeking. Future research should prioritise updated, validated instruments and expand population-based studies across settings. Effective population-level interventions will need to target not only the public but also healthcare professionals and policymakers to improve care and outcomes for people with back pain.

References: 1. Hartvigsen J, et al: What low back pain is and why we need to pay attention. The Lancet 2018.
2. Estee MM, et al.: Negative back beliefs are associated with increased odds of low back pain and disability: a 10-year cohort study in men. Rheumatology 2023.
3. Buchbinder R, et al: The Lancet Series call to action to reduce low value care for low back pain: an update. PAIN 2020.
4. Grøn S, et al: What do people believe to be the cause of low back pain? A scoping review. Braz J Phys Ther 2023.

Presenting Author: Jeremy R Chang
Submitting Author: Jeremy Chang

Senior Author: Adrian C Traeger

IASP 2026 Global Year theme of Neuropathic Pain: No

• Chris G Maher: PhD - The University of Sydney
• Sweekriti Sharma: PhD - The University of Sydney
• Aidan Van Wyk: BSc - The University of Sydney
• Arnold YL Wong: PhD - The Hong Kong Polytechnic University
• Rachelle Buchbinder: PhD - Monash University
• Florian Bailly: PhD - Sorbonne université
• Hazel Jenkins: PhD - Macquarie University
• Adrian C Traeger: PhD - The University of Sydney