Perceived educational reassurance, pain intensity, and fear-avoidance: insights from a secondary analysis of low back pain data

Perceived reassurance about low back pain (LBP) can influence psychological and behavioral responses to pain, including pain intensity and fear-avoidance beliefs. This study explored how messages about LBP contribute to variations in these responses. A secondary analysis of a cross-sectional study was conducted, including 957 participants with non-specific LBP who completed an online survey. The majority of participants were female (69.1%), and 55% reported acute LBP. The survey collected demographic data, pain intensity ratings using a numeric scale, fear-avoidance beliefs through the Fear-Avoidance Beliefs Questionnaire (FABQ), and perceived reassurance, defined as the extent to which participants felt hindered or reassured by each message (rated on a 0-10 Likert scale). Linear regression models were developed using stepwise methods to examine the relationship between perceived reassurance and psychological responses. One model indicated that an educational message ('If not taken seriously, back pain can persist for a long period of time and can become disabling') emphasizing the risks of prolonged and disabling LBP, along with demographic and condition-specific factors, explained 9.4% of variance in pain intensity (p < 0.001). Further analysis revealed messages promoting positive outcomes and proactive behaviors such as 'Getting back to activity and keeping your physical fitness and exercising will help alleviate your problem' significantly influenced FABQ scores (adjusted R² (%) = 1.8% for FABQ-PA, 3.2% for FABQ-W, p < 0.05). These findings reveal the role of communication in shaping perceptions and behaviors related to LBP. While risk-awareness messaging can elevate pain perceptions, reassurance-based messages encouraging activity may help mitigate fear-avoidance beliefs. This study demonstrates the importance of tailoring educational messages (as a modifiable factor) in clinical settings to enhance reassurance, reduce fear-avoidance, and promote proactive pain management strategies.