Purpose and Background: A clinical scenario and questionnaire was used to examine how back pain advice may be influenced by a clinician’s interpretation of an investigation and by their pre-existing beliefs about pain.

Methods: All pain clinics in the Dr. Foster report and a randomized sample of 200 General Practitioners were sent a questionnaire based on a presenting 42 yr old male patient with chronic back pain but no sciatica. An MR scan shows “degenerative changes in the L4/L5 discs, both of which are narrowed and dehydrated. A disc tear can be seen at L4/5 with a small central prolapsed disc. There is no evidence of any significant thecal or root compression.”

The questionnaire comprised statements paired with a 7-point scale, ranging from 0 (do not agree) to 6 (completely agree), therefore respondents marking 0–2 would be disagreeing, and those marking 4–6 would be agreeing with that statement.

97/109 (90%) respondents agreed the patient could continue to live normally, 38 (35%) would say the scan is essentially normal and 51 (47%) would not. 21/109 (19%) would say the scan is significantly abnormal and were likely to give restrictive movement advice (13/21 v 26/88: p=0.01). Clinicians who advise against painful movements were likely to seek a surgical opinion (19/32 v 13/77: p< 0.0001)

Conclusions: Clinicians advising against painful movements are highly likely to seek surgical opinions for back pain and those who interpret an investigation as abnormal are likely to give restrictive movement advice. Clinician education in back pain should take account of these findings.