Low back pain is one of the most common reasons people seek healthcare. Yet two people with very similar symptoms can have very different experiences.
One person may remain active, follow a treatment plan, and gradually improve. Another may become increasingly worried, seek multiple opinions, request imaging, and continue searching for answers.
Why does this happen?
A recent study published in Musculoskeletal Science and Practice suggests that the answer may lie partly in how people think and feel about their back pain.
Understanding Illness Perceptions
Researchers use the term illness perceptions to describe the beliefs and emotions people have about a health condition.
These perceptions include questions such as:
- How serious is my problem?
- How long will it last?
- Do I have any control over it?
- Will treatment help?
- Is my spine damaged?
- Should I be worried?
These beliefs are important because they influence behaviour. They affect how we interpret symptoms, whether we remain active, how often we seek healthcare, and what we expect from treatment.
The Study
Researchers in Denmark followed 214 adults who consulted their family physician for low back pain. At their initial visit, participants completed the Brief Illness Perception Questionnaire (BIPQ), a tool designed to measure how people view and emotionally respond to their condition.
Three months later, researchers examined:
- How often patients sought healthcare for their back pain
- Whether they underwent diagnostic imaging such as X-ray, CT, or MRI
Importantly, the researchers adjusted for pain intensity, disability, and symptom duration. This allowed them to determine whether illness perceptions influenced healthcare decisions independently of symptom severity.
What Did They Find?
The results were revealing.
People who viewed their back pain as more threatening were more likely to:
- Seek repeated healthcare consultations
- Undergo diagnostic imaging
This relationship remained even after accounting for pain severity and disability.
Patients with the most threatening perceptions had a 36% probability of multiple healthcare visits compared with 26% among those with less threatening perceptions. They were also more likely to receive diagnostic imaging.
Perhaps most interestingly, emotional responses to back pain were strongly associated with repeated healthcare use, while expectations that the condition would persist were associated with greater use of imaging.
In other words, how people interpreted their symptoms appeared to influence what they did next.
What I See in Clinical Practice
After more than 25 years in practice, these findings resonate with what I observe every day.
Many patients arrive with understandable concerns. Some worry that a disc has “slipped out.” Others fear that bending, lifting, or movement will cause further damage. Many assume that severe pain must indicate severe injury.
Often, the greatest source of distress is not the pain itself but uncertainty.
Patients want answers to questions such as:
- What is causing my pain?
- Is my spine damaged?
- Will this become permanent?
- Do I need an MRI?
- Is it safe to move?
When these questions remain unanswered, it is understandable that people continue searching for reassurance through additional consultations, imaging, or multiple treatment approaches.
How Anatomical Models Can Help
One of the reasons I developed Dynamic Disc Designs (ddd) spinal models was to help bridge this gap in understanding.
Back pain can be difficult to explain using words alone. Terms such as disc bulge, degeneration, arthritis, stenosis, instability, or nerve irritation are often unfamiliar to patients and can sometimes sound frightening.
When patients can see and hold an anatomical model, the conversation often changes.
A model allows us to discuss:
- Normal spinal anatomy
- Disc structure and function
- Age-related changes
- Nerve pathways
- Movement and loading
- Healing and adaptation
Rather than imagining that their spine is fragile or permanently damaged, patients often gain a more realistic understanding of what may be occurring.
The goal is not to identify every painful tissue with certainty. In many cases that is not possible. Instead, the goal is to help patients develop a clearer, less threatening, and more accurate understanding of their condition.
Interestingly, this aligns closely with the findings of the current study. The researchers found that emotional responses and beliefs about the future course of back pain were associated with healthcare utilization. Patient education may help address these concerns by replacing uncertainty with understanding.
As chiropractors, physiotherapists, physicians, and other healthcare professionals know, understanding is often the first step toward confidence. When patients better understand their condition, they may feel less fearful, more capable of participating in their recovery, and less dependent on repeated testing or consultations for reassurance.
Why Imaging Is Not Always the Answer
The study also found that people who believed their condition would last longer were more likely to undergo diagnostic imaging.
This is something clinicians encounter frequently.
Many patients hope an MRI will provide definitive answers. However, research consistently shows that imaging findings often do not correlate well with symptoms.
Disc bulges, degeneration, facet joint changes, and other age-related findings are common in people who have no pain at all.
This does not mean imaging is never appropriate. Diagnostic imaging can be essential when serious pathology is suspected or when clinical findings warrant further investigation.
However, for most episodes of low back pain, education, reassurance, movement, and active management are often more important than obtaining another image.
The Importance of Communication
One of the most valuable lessons from this study is that effective care involves more than diagnosing tissues and structures.
Patients bring beliefs, experiences, fears, expectations, and questions into every consultation.
Taking time to understand these concerns can help clinicians provide more meaningful reassurance and more individualized care.
Sometimes the most important intervention is not a treatment.
Sometimes it is helping a patient understand what is happening and why recovery remains possible.
Take-Home Message
This study reminds us that low back pain is not solely a physical experience.
Pain intensity, disability, and tissue health matter. But the way people interpret their symptoms matters too.
People who view their condition as more threatening are more likely to seek repeated healthcare and diagnostic imaging, even when symptom severity is taken into account.
For clinicians, this highlights the importance of education and communication.
For patients, it serves as a reminder that understanding your condition may be just as important as treating it.
A better understanding can reduce fear, improve confidence, support active recovery, and help people make informed decisions about their care.
Perhaps one of the most important questions we can ask patients is not simply, “Where does it hurt?” but rather, “What do you think is happening, and what concerns you most about it?”
Reference
Arnbak BA, Hartvigsen J, Andersen JS, Møller A, Nørgaard B, Kongsted A. Illness perceptions and healthcare use among people with low back pain in general practice. Musculoskeletal Science and Practice. 2026;84:103602. DOI: 10.1016/j.msksp.2026.103602