1. Research the threat

Key questions to ask:

What do you think you've done to your back?

What's the worst thing that could be happening in your back? How severe is your problem?
What do you fear most about it?

When you feel the pain, what is it telling you? What does it mean?

Do you think you could make your back worse?

Is there anything which worries or concerns you about your back at the moment?

Orange flags

Beliefs which increase the threat

Identify these beliefs so that the rationale behind them can be discussed

White flags

Factors which will influence the pain, but you cannot change within the consultation

Acknowledge these factors so that their influence upon the pain experience can be explained

Attitudes and beliefs

Patient attitudes and beliefs are predictive of low back pain outcome, whereas most pathoanatomical features are not.

A poor recovery is predicted by factors like poor expectations, anxiety, and avoidance of activity, not how the episode started, or what has been injured.

Health professionals are very influential upon patient beliefs about back pain.