How Facebook is helping to identify thousands suffering from inflammatory back pain


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You can use it to raise funds for your favorite animal rescue, to advertise your latest stoop sale and to crowdsource opinions on the best ways to grill a steak. Now a new study is taking a look at how using Facebook to raise awareness about the symptoms of inflammatory back pain (IBP) has become key in identifying IBP patients sooner than other approaches, including newspaper advertisements.

The results of the U.K. study, which were presented recently at the European League Against Rheumatism Annual Congress (EULAR 2016), highlighted the need for patients to seek medical help early to reduce the risk of severe functional disability and early retirement.


Mechanical versus inflammatory

Correct diagnosis depends largely on the pattern of clinical symptoms and signs in addition to magnetic resonance imaging. Early diagnosis has become all the more important because biological therapies such as TNF inhibitors are available that effectively suppress disease activity and improve functional ability in patients that have been refractory to conventional drug therapy.

A previous U.K. study showed an average delay in diagnosis of more than eight years, with almost one-third of diagnosed patients not referred to a rheumatologist. This is partly due to a failure of individuals with IBP symptoms to present to their general practitioner, and partly to a failure of general practitioners to recognize patients with chronic back pain who have an inflammatory rather than a mechanical cause.

According to the Cleveland Clinic, the source of mechanical back pain is typically in the spinal joints, discs, vertebrae or soft tissues. Inflammatory back pain, on the other hand, is believed to be caused by certain autoimmune diseases, such as psoriatic arthritis, for example.

"Patients with inflammatory back pain (IBP) can wait years for a correct diagnosis. Early treatment is critical in achieving better outcomes for these patients. We applied a novel recruitment method using Facebook over five months to identify adults in the community with symptoms suggestive of IBP, comparing the outcome with other forms of recruitment, principally newspaper advertising," said Dr. Arumugam Moorthy of the Department of Rheumatology, University Hospitals of Leicester NHS trust, U.K. "Facebook advertising recruited a younger group of respondents and a higher proportion of them fulfilled the criteria for a diagnosis of IBP compared to the group of patients recruited by other methods."

Back pain is one of the most common medical complaints; it has been estimated to affect as many as 17.3 million people in the U.K. However, the majority of these cases are due to a mechanical rather than an inflammatory cause. Among those patients presenting to their doctor at least once with back pain, the minimum estimated prevalence of IBP is equivalent to around 700,000 people. Patients with IBP typically experience severe lower back pain worse at night, not helped by rest, which can significantly interfere with an individual's mental health, ability to work and quality of life.

Of the 585 participants in this study, just over three quarters were recruited through Facebook and under one quarter by other methods. The mean age of the Facebook group was typical of IBP at 41.5 years; the mean age of the non-Facebook group was higher at 59.4 years. Three quarters of the recruited patients were female. Online questionnaire-based surveys to assess the two groups of recruited patients for a diagnosis of IBP showed that, among those recruited by Facebook, 56% met the Calin criteria and ASAS criteria for IBP. In contrast, in the group recruited by non-Facebook methods, 39% met the Calin and ASAS criteria.

The majority of patients from each group reported consulting their general practitioner; however, few patients from either group had been referred to a rheumatologist. Regarding further investigations, 45% of the Facebook group reported having an MRI scan and 45% an X-ray, whereas 50% of the non-Facebook group reported having an MRI scan and 59% said they had been for an X-ray.

"Although most (81%) of the chronic back pain patients we recruited through Facebook had consulted their GP, only 13% had actually been referred to a rheumatologist, confirming the need for additional GP education," Dr Moorthy concluded.