A new analysis published in the European Journal of Pain shows that patients with low back pain who were able to recall key messages from patient education achieved better treatment outcomes.
A research group analysed data from 3,850 participants in the Danish GLA:D Back programme, which combines patient education and supervised exercise. The aim was to investigate whether patients’ awareness of key reassuring messages after three months influenced pain, function, and psychological factors after six months.
The messages included in the study were:
- The back is built to be used.
- There are movements or positions that should be avoided.
- Pain is not a sign of injury.
- The brain remembers pain, like a bad song that gets stuck in your head.
- Activity and exercise are part of the solution.
Participants were expected to recognize three of the messages, while ideally not recognizing the other two.
Greater Awareness Led to Better Outcomes
Overall, 57% of participants reported increased awareness of the key messages after completing the program, while 14% reported decreased awareness.
The messages that were most often new to patients during the GLA:D Back program were:
- “Pain is not a sign of injury”, where the proportion of patients recognizing the message increased from 46.8% at the start of the program to 83.8% after completion.
- “The brain remembers pain”, where recognition increased from 44.1% to 81.3%.
After accounting for other differences between patients, those who remembered the key reassuring messages better after three months were more likely to have viewed their condition as less serious at baseline and to have had greater confidence in their own abilities. Older individuals, men, and people with more leg pain and a tendency to avoid activities were less aware of the same messages after three months.
For every key message a patient remembered:
- Pain intensity was on average 0.27 points lower on a 0–10 scale.
- Disability was 1.01 points lower on the Oswestry Disability Index.
- Fear of movement was 0.85 points lower on the FABQ scale.
The effects were statistically significant but relatively small. The researchers therefore emphasize that reassuring messages alone are unlikely to produce clinically meaningful improvements but probably function as an important component of a multimodal treatment strategy.
The study’s main conclusion is clear: Patients who were more aware of the key messages after three months experienced less pain, less disability, and less fear of movement six months after treatment began.
Communication Is an Important Part of Overall Treatment
The findings support the growing body of evidence showing that communication between clinician and patient is an important part of the overall treatment of chronic low back pain.
The results suggest that what patients learn about their pain matters. Patient education is not simply about providing information but about ensuring that patients understand and remember the key messages.
When patients understand that the back is robust, that movement is safe, and that pain does not necessarily reflect tissue damage, this appears to contribute to better long-term outcomes in the form of less pain, less disability, and less fear of movement.
The study strengthens the case for prioritizing targeted reassuring information, pain education, and positive messages about movement as an integrated part of treatment.
For chiropractors, this may be an important indication that some patient groups require more targeted communication, repetition, and follow-up to ensure that the key messages are truly understood and incorporated.
The researchers highlight that these messages are inexpensive, easy to implement, and associated with no significant risks. Therefore, they should be included as a natural part of evidence-based management of chronic low back pain, even though their isolated effects are modest.
Anika Young, Adrian Traeger, Simon French, Alice Kongsted, Mark Hancock, Inge Ris, Simon Kirkegaard, Hazel Jenkins. Does Awareness of Key Reassuring Messages Influence Patient Outcomes in Participants With Chronic Low Back Pain? Secondary Analysis of an Observational Study in Primary Care. European Journal of Pain 2026.
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