We have found that social factors can be central to the concerns of those with LBP and could
be drivers for more costly (to both the individual and to society) and complex sequelae, such
as depression. The lack of impetus to measure social factors could be indicative of a more
general failure to recognise the role or influence of society in the management of chronic pain
conditions. Geoffrey Rose discussed the merits of adopting the strategy of treating the sick
population rather than the sick individual [77]; yet so far, population targeted interventions
have hitherto been confined to only more obvious public health concerns such as heart
disease, smoking, and obesity. The more lateral-thinking future LBP clinical trialist might be
tempted to develop a back pain intervention that is aimed at changing population attitudes to
back pain. In order for the word ‘illness’ to become ‘wellness’ the ‘I’ must be changed for
‘We’ – by useful coincidence, such rhetoric may serve as an allegory for the sociological
changes that may be needed in order to shift the whole population pain distribution to the left,
reducing the burden, and in so doing helping sick individuals. One example approach might be the use of media-based interventions, similar to that which have been used in the UK since
2007 to change attitudes and reduce the stigma associated with mental health conditions
(http://www.time-to-change.org.uk/about-us/about-our-campaign/start-your-conversation-
2013), using a cluster trial design where randomisation is performed by broadcast region.
Alternatively, cluster trials of interventions targeted at the workplace to change culture and
attitudes could be explored, as was done in the Victorian Workcover back injury prevention
programme
We have found that social factors can be central to the concerns of those with LBP and couldbe drivers for more costly (to both the individual and to society) and complex sequelae, suchas depression. The lack of impetus to measure social factors could be indicative of a moregeneral failure to recognise the role or influence of society in the management of chronic painconditions. Geoffrey Rose discussed the merits of adopting the strategy of treating the sickpopulation rather than the sick individual [77]; yet so far, population targeted interventionshave hitherto been confined to only more obvious public health concerns such as heartdisease, smoking, and obesity. The more lateral-thinking future LBP clinical trialist might betempted to develop a back pain intervention that is aimed at changing population attitudes toback pain. In order for the word ‘illness’ to become ‘wellness’ the ‘I’ must be changed for‘We’ – by useful coincidence, such rhetoric may serve as an allegory for the sociologicalchanges that may be needed in order to shift the whole population pain distribution to the left,reducing the burden, and in so doing helping sick individuals. One example approach might be the use of media-based interventions, similar to that which have been used in the UK since2007 to change attitudes and reduce the stigma associated with mental health conditions(http://www.time-to-change.org.uk/about-us/about-our-campaign/start-your-conversation-2013), using a cluster trial design where randomisation is performed by broadcast region.
Alternatively, cluster trials of interventions targeted at the workplace to change culture and
attitudes could be explored, as was done in the Victorian Workcover back injury prevention
programme
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