A systematic review and meta-synthesis of the impact of low back pain on people’s lives

Abstract

BackgroundLow back pain (LBP) is a common and costly problem that many interpret within a biopsychosocial model. There is renewed concern that core-sets of outcome measures do not capture what is important. To inform debate about the coverage of back pain outcome measure core-sets, and to suggest areas worthy of exploration within healthcare consultations, we have synthesised the qualitative literature on the impact of low back pain on people’s lives.MethodsTwo reviewers searched CINAHL, Embase, PsycINFO, PEDro, and Medline, identifying qualitative studies of people’s experiences of non-specific LBP. Abstracted data were thematic coded and synthesised using a meta-ethnographic, and a meta-narrative approach.ResultsWe included 49 papers describing 42 studies. Patients are concerned with engagement in meaningful activities; but they also want to be believed and have their experiences and identity, as someone ‘doing battle’ with pain, validated. Patients seek diagnosis, treatment, and cure, but also reassurance of the absence of pathology. Some struggle to meet social expectations and obligations. When these are achieved, the credibility of their pain/disability claims can be jeopardised. Others withdraw, fearful of disapproval, or unable or unwilling to accommodate social demands. Patients generally seek to regain their pre-pain levels of health, and physical and emotional stability. After time, this can be perceived to become unrealistic and some adjust their expectations accordingly.ConclusionsThe social component of the biopsychosocial model is not well represented in current core-sets of outcome measures. Clinicians should appreciate that the broader impact of low back pain includes social factors; this may be crucial to improving patients’ experiences of health care. Researchers should consider social factors to help develop a portfolio of more relevant outcome measures.

Barriers to self-management of chronic pain in primary care: a qualitative focus group study

“…Metaethnographies or meta-synthesis of such studies provide a useful comparator for the current study. The findings resonate with many of the themes discussed: the adversarial struggle to affirm self, explain pain, negotiate the healthcare system, and to be valued and believed; 25 the undermining and disempowering impact of pain, and unsatisfying relationships with healthcare providers; 26 difficulties with activities and stigma; 27 and the impact on self and relations with significant others. 28 The same studies find some evidence of moving forward with pain, accepting and adjusting, and changing outlook.…”

Core outcome domains for clinical trials in non-specific low back pain

“…Taking into account the widely accepted bio-psycho-social model for LBP [42,43], it may be appropriate to have a domain like 'health-related quality of life' in this COS as its definition includes all components of the model ( Table 2). The inclusion of all components of the bio-psycho-social model is also in line with the domains included in a conceptual framework developed to characterize the burden of LBP [35] and with the results of a review that attempted to summarize qualitative research conducted on the impact of LBP on people's lives [44]. However, it will be clear only when choosing measurement instruments for this COS if the different components of 'health-related quality of life' can be treated as separate domains or as one multidimensional domain.…”

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

“…A systematic review of qualitative studies has also identified that current outcome measures may not be adequately capturing the social component of the impact of LBP. 156 Although the numbers in our study are limited, people appear to have been able to complete the adapted follow-up PGI score satisfactorily. The results show the expected improvement over time.…”