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Testing a Model of Consultation-based Reassurance and Back Pain Outcomes with Psychological Risk as Moderator: A Prospective Cohort Study

Holt Nicola PhD; Mansel, Gemma PhDl; Hil, Jonathan C. PhDl; Pincus, Tamar PhD
The Clinical Journal of Pain: Post Acceptance: September 28, 2017
doi: 10.1097/AJP.0000000000000541
Original Article: PDF Only


Reassurance is an essential part of treatment for low back pain (LBP), but evidence on effective methods to deliver reassurance remains scarce. The interaction between consultation-based reassurance and patients’ psychological risk is unknown. Our objective was to investigate the relationship between consultation-based reassurance and clinical outcomes at follow up, in people with and without psychological risk.


We tested the associations between specific reassurance components (data gathering; relationship building, generic reassurance and cognitive reassurance), patients’ psychological risk (the presence of depression, anxiety, catastrophizing or fear-avoidance), and post-consultation outcomes including; satisfaction and enablement, disability, pain and mood at 3-month follow-up.


Adjusted linear regression models using data from patients who had recently consulted for LBP in primary care (n=142 in 43 practices) indicated that all reassurance components were strongly associated with increased satisfaction, while generic reassurance was significantly associated with post-consultation enablement. Generic reassurance was also associated with lower pain at three months, while cognitive reassurance was associated with increased pain. A significant interaction was observed between generic reassurance and psychological risk for depression at three-months: high rates of generic reassurance were associated with lower depression in low risk patients, but with higher rates of depression for high risk groups.


The findings support the hypothesis that different components of reassurance are associated with specific outcomes, and that psychological risk moderates this relationship for depression. Doctors’ reassuring behaviours might therefore have the potential to improve outcomes in people with LBP, especially for patients with higher psychological risk profiles.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Nicola Holt was supported by a studentship from the Economic and Social Research Councils’ Doctoral Training Centre. She was supervised by Tamar Pincus. This study was supported by a grant from EuroSpine to Tamar Pincus. Jonathan Hill is supported through a NIHR Research Professorship (NIHR-RP-011-015) which is held by Nadine Foster. Gemma Mansell is supported by National Institute for Health Research (NIHR) School for Primary Care Research Seedcorn funding. This report is independent research by the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

The authors declare no conflict of interest.

Reprints: Tamar Pincus, PhD, Department of Psychology, Royal Holloway, University of London, Egham, Surrey, TW20 0EX (e-mail:

Received March 17, 2017

Accepted July 19, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.