Living with chronic low back pain: a metasynthesis of qualitative research

Abstract

OBJECTIVES The purpose of this qualitative metasynthesis is to articulate the knowledge gained from a review of qualitative studies of patients' experiences of chronic low back pain. METHODS Meta-ethnographic methodology guided the review of 33 articles representing 28 studies published in English in peer-reviewed journals between 2000 and 2012. A systematic comparison of the main themes from each study was conducted and 'synthesised' to create superordinate themes. RESULTS Three overarching interrelated themes were identified: the impact of chronic low back pain on self; relationships with significant others that incorporated two streams - health professionals and the organisation of care and relationships with family and friends; coping with chronic low back pain. Coping strategies were predominantly physical therapies, medication and avoidance behaviours with very few successful strategies reported. Professional and family support, self-efficacy, motivation, work conditions and exercise opportunities influenced pain experiences. Review authors' recommendations included psychological therapies, education, the facilitation of self-management strategies and support groups. DISCUSSION The review substantiates chronic low back pain as complex, dynamic and multidimensional, underpinned by experiences of persistent distressing pain, loss, and lowered self-worth, stigma, depression, premature aging, fear of the future. Future research should address the paucity of longitudinal studies, loss and issues of ethnicity, gender, ageing.

‘I think positivity breeds positivity’: a qualitative exploration of the role of family members in supporting those with chronic musculoskeletal pain to stay at work

“…However, for significant others, talking about the worker's pain may have also helped alleviate their own concerns, some of which were highlighted in this theme. This aligns with other research in this area and illustrates the complexities which can arise due to the different needs between those experiencing pain and those close to them: those with chronic pain are fearful of the demands their condition places on others and tend to minimize its impact, but those close to them need to have opportunities to access their own support in order to reduce the burden placed on them and help to attenuate any maladaptive appraisals of chronic pain [26,34,35], but also to have their feelings and experiences recognized in order to provide them with evidence they are in a strong, reciprocal relationship [36]. These findings indicate that those with chronic pain and their significant others may have different information and support needs, and that addressing both could counteract any negative outcomes related to relationship disparities.…”

Barriers to self-management of chronic pain in primary care: a qualitative focus group 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. Fewer empirical studies include HCP experiences.…”

The impact of chronic low back pain is partly related to loss of social role: A qualitative study

“…As defined by the World Health Organisation, this condition is accepted as a biopsychosocial phenomenon in which anatomical injury interplays with other factors [2]. Beyond pain and disability, psychological and social aspects have a significant impact on living with chronic LBP [3][4][5][6][7][8][9][10][11][12]. Mental aspects of chronic LBP are related to psychological distress, in particular anxiety and depression [3][4][5][6][7].…”