Individuals’ explanations for their persistent or recurrent low back pain: a cross-sectional survey

Abstract

BackgroundMost people experience low back pain (LBP), and it is often ongoing or recurrent. Contemporary research knowledge indicates individual’s pain beliefs have a strong effect on their pain experience and management. This study’s primary aim was to determine the discourses (patterns of thinking) underlying people’s beliefs about what causes their LBP to persist. The secondary aim was to investigate what they believed was the source of this thinking.MethodsWe used a primarily qualitative survey design: 130 participants answered questions about what caused their LBP to persist, and where they learned about these causes. We analysed responses about what caused their LBP using discourse analysis (primary aim), and mixed methods involving content analysis and descriptive statistics to analyse responses indicating where participants learnt these beliefs (secondary aim).ResultsWe found that individuals discussed persistent LBP as 1) due to the body being like a ‘broken machine’, 2) permanent/immutable, 3) complex, and 4) very negative. Most participants indicated that they learnt these beliefs from health professionals (116, 89%).ConclusionsWe concluded that despite continuing attempts to shift pain beliefs to more complex biopsychosocial factors, most people with LBP adhere to the traditional biomedical perspective of anatomical/biomechanical causes. Relatedly, they often see their condition as very negative. Contrary to current “best practice” guidelines for LBP management, a potential consequence of such beliefs is an avoidance of physical activities, which is likely to result in increased morbidity. That health professionals may be the most pervasive source of this thinking is a cause for concern. A small number of people attributed non-physical, unknown or complex causes to their persistent LBP – indicating that other options are possible.

How do people in China think about causes of their back pain? A predominantly qualitative cross-sectional survey

“…Pain beliefs are thought to differ between countries and cultures (8). A recent study reported four thinking patterns (discourses) underlying beliefs of Australians about the causes of persistent or recurrent LBP (9). The discourses were predominantly biomechanical or anatomical, which is in line with the traditional western biomedical view of health (9).…”

“…A recent study reported four thinking patterns (discourses) underlying beliefs of Australians about the causes of persistent or recurrent LBP (9). The discourses were predominantly biomechanical or anatomical, which is in line with the traditional western biomedical view of health (9). As Chinese philosophies are nested into people's daily life in China, it is likely that these philosophies would influence thinking about health for people living in China (10).…”

“…This study used a cross-sectional online survey which was based on an earlier Australian survey exploring LBP beliefs (9). The study was approved by the scientific and ethical review board of Vrije Universiteit Amsterdam (VCWE, number 2019-065R1).…”

Use of Manual Therapy for Posterior Pelvic Girdle Pain

“…Clinicians must be mindful of achieving buy‐in for program participation without promoting a narrative that patients are “broken” via a mechanistic explanation of pain . This type of explanation can lead to negative outcomes over the long term …”

“…38 This type of explanation can lead to negative outcomes over the long term. 39,40 Utilization If manual therapy is to be used, clinician-patient communication should emphasize a positive prognosis rather than a mechanical diagnosis. 40 Psychosocial factors have been shown to play a significant role in the prognosis of low back, knee, and shoulder pain.…”