Medical knowledge and the intractable patient: the case of chronic low back pain

May, Carl; Doyle, Helen; Chew‐Graham, Carolyn

doi:10.1016/s0277-9536(98)00372-4

Cited by 54 publications

(37 citation statements)

References 32 publications

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“…44 Moreover, there are readily demonstrable disparities in the degree and quality of health care afforded minorities and the poor, 45 including in the specific context of acute low back pain, 46 a tendency that may be compounded in situations involving chronic pain or musculoskeletal disorders, conditions that carry pejorative weight independent of salient social factors like race and income. 47,48 Negative race-and class-based differences in communication, trust, and empathy enacted in the medical treatment context may also increase feelings of alienation and dissatisfaction in minority or lower SES injured workers, with a consequent negative impact on response to treatment. 45,49,50 In addition to factors directly associated with work and treatment for occupational injury, life stresses associated with minority or lower SES status (eg, housing and living conditions, finances, educational prospects, insurance, healthcare quality, transportation, child care, racism, classism) have negative associations with morbidity risk, recovery from illness, and disability.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Social Predictors of Application for Social Security Disability Insurance by Workers??? Compensation Claimants With Low Back Pain

Chibnall

Tait

Andresen

et al. 2006

Journal of Occupational and Environmental Medicine

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Section: Discussionmentioning

confidence: 99%

Clinical and Social Predictors of Application for Social Security Disability Insurance by Workers??? Compensation Claimants With Low Back Pain

Chibnall

Tait

Andresen

et al. 2006

Journal of Occupational and Environmental Medicine

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“…Patients with unexplained chronic musculoskeletal pain can be particularly difficult to help; they may follow a particularly complex "illness career path" (3), accessing a range of services before consulting specialist pain services (4). Conflicts between the explanatory models of illness used by patients and health professionals might contribute to this complex care-seeking career, increasing the likelihood of unsatisfactory outcomes for both practitioners and patients (5,6). These problems may be particularly important for patients whose pain is difficult to manage and who are seen in specialist pain clinics.…”

Section: Introductionmentioning

confidence: 99%

“It struck me that they didn't understand pain”: The specialist pain clinic experience of patients with chronic musculoskeletal pain

Harding

Parsons

Rahman

et al. 2005

Arthritis & Rheumatism

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Objective. To explore the experiences of diagnosis and management among patients who attended a specialist musculoskeletal pain clinic and the factors influencing their interpretation of these experiences. Methods. A postal questionnaire was sent to potential participants 6 -20 months after their first clinic attendance. Data were collected on pain presence, severity, and location; health-related quality of life; psychological distress; and care-seeking behavior. Questionnaire data were used to inform combined purposive and theoretical sampling. In-depth interviews were conducted that probed participants' understanding of their chronic musculoskeletal pain and its management in a specialist musculoskeletal pain clinic. Results. Fifteen patients were interviewed. Four main themes were identified: spoiled identity (pain limited patients' activities so extensively that it affected their sense of self); diminishing faith in medicine (patients were disappointed with aspects of their care-seeking experience); making sense of pain (patients made sense of their pain by locating their pain within the context of their lives); and learning to live with the pain (an issue for all patients was whether or not their pain would stop or whether they had to learn to live with it). Conclusion. Developing, implementing, and evaluating approaches to address patients' spoiled identities might allow us to improve patient-centered outcomes in chronic musculoskeletal pain.

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“…8,9 The diffi culties encountered in presenting LBP to clinicians have also been extensively studied, highlighting issues such as the way in which people describe pain and its consequences, being believed, differences in defi ning pain between clinicians and patients, and the uncertainty surrounding the diagnosis, treatment, and outcomes. [10][11][12][13][14] Sciatica, or more specifi cally lumbar radiculopathy, 15 is one of the commonest variations of LBP 16,17 and is usually defi ned as pain radiating to the leg, particularly below the knee and into the foot and toes, with a variety of accompanying neurological features. Unlike LBP alone, sciatica more often has a recognizable "biomedical" etiology such as lumbar disc herniation, or less commonly lumbar canal or foraminal stenosis.…”

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confidence: 99%

Patientsʼ Own Accounts of Sciatica

Ong

Konstantinou²,

Corbett³

et al. 2011

Spine

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STUDY DESIGN.: Longitudinal qualitative interview study, nested within a back pain cohort study. OBJECTIVE.: Enhance the understanding of patients' own perspectives on living with sciatica to inform improvements in care and treatment outcomes. SUMMARY OF BACKGROUND DATA.: Reports of patients' own accounts of sciatica and its impact on daily life are still scarce. Research on back pain has shown that it is important to understand how people live with pain and how they perceive interactions with health care professionals and interpret interventions. These types of insights help to improve treatments and their acceptability to patients. METHODS.: In-depth qualitative interviews with 37 people at baseline and 6 and 12 months' follow-up. The interviews covered topics that were derived from the Illness Perceptions Questionnaire and allowed open-ended talk about people's experiences of pain. All interviews were tape-recorded, fully transcribed, and thematically analyzed. RESULTS.: People needed to make sense of sciatica through identifying a cause and having it clinically diagnosed. The impact of sciatic pain was seen to be constant, intense, and all-encompassing. Appreciation of this by clinicians was considered important, as well as the provision of clear information about treatment and prognosis. Expectations about treatment options varied between patients, and people balanced pain relief with adverse effects. CONCLUSION.: Our study highlights patients' own accounts of the distinctiveness, impact, and intrusiveness of their sciatic symptoms. Our findings emphasize the importance of leg pain in identifying a subgroup of back-pain patients more likely to have severe symptoms, be at risk of poor outcome, and who should be considered a priority for early diagnosis and management. Future management of sciatica needs to include listening to patients' stories, offering a credible physical assessment, explanation, and diagnosis of the condition. Explaining the limits to treatment is seen as positively contributing to the partnership between patients and clinicians.

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Medical knowledge and the intractable patient: the case of chronic low back pain

Cited by 54 publications

References 32 publications

Clinical and Social Predictors of Application for Social Security Disability Insurance by Workers??? Compensation Claimants With Low Back Pain

Clinical and Social Predictors of Application for Social Security Disability Insurance by Workers??? Compensation Claimants With Low Back Pain

“It struck me that they didn't understand pain”: The specialist pain clinic experience of patients with chronic musculoskeletal pain

Patientsʼ Own Accounts of Sciatica

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