The influence of 'significant others' on persistent back pain and work participation: A qualitative exploration of illness perceptions

Abstract

BackgroundIndividual illness perceptions have been highlighted as important influences on clinical outcomes for back pain. However, the illness perceptions of 'significant others' (spouse/partner/close family member) are rarely explored, particularly in relation to persistent back pain and work participation. The aim of this study was to initiate qualitative research in this area in order to further understand these wider influences on outcome.MethodsSemi-structured interviews based on the chronic pain version of the Illness Perceptions Questionnaire-Revised were conducted with a convenience sample of UK disability benefit claimants, along with their significant others (n = 5 dyads). Data were analysed using template analysis.ResultsSignificant others shared, and perhaps further reinforced, claimants' unhelpful illness beliefs including fear of pain/re-injury associated with certain types of work and activity, and pessimism about the likelihood of return to work. In some cases, significant others appeared more resigned to the permanence and negative inevitable consequences of the claimant's back pain condition on work participation, and were more sceptical about the availability of suitable work and sympathy from employers. In their pursuit of authenticity, claimants were keen to stress their desire to work whilst emphasising how the severity and physical limitations of their condition prevented them from doing so. In this vein, and seemingly based on their perceptions of what makes a 'good' significant other, significant others acted as a 'witness to pain', supporting claimants' self-limiting behaviour and statements of incapacity, often responding with empathy and assistance. The beliefs and responses of significant others may also have been influenced by their own experience of chronic illness, thus participants lives were often intertwined and defined by illness.ConclusionsThe findings from this exploratory study reveal how others and wider social circumstances might contribute both to the propensity of persistent back pain and to its consequences. This is an area that has received little attention to date, and wider support of these findings may usefully inform the design of future intervention programmes aimed at restoring work participation.

The Utility of Template Analysis in Qualitative Psychology Research

“…Findings from this research suggest that there is a danger that patients who feel unable to stay in or return to their previous employment may adopt a very limiting "disabled" identity as a protection from socio-cultural scepticism about their condition, and derogatory rhetoric about "benefits scroungers." Such a strategy for defending the self may lead to a vicious circle whereby the patient focuses on what s/he cannot do, restricts activity further, and exacerbates the condition making it even less likely they will be able to return to work (McCluskey et al 2011;Brooks et al 2013). In the CSM framework, "illness identity" pertains to the specific symptoms associated by a patient with an illness, ideas about the label given to an illness, and beliefs about its nature.…”

“…Patient and significant other beliefs about back pain and work participation: An example of a study using existing theory in template development Our second example used Template Analysis in a rather different way to meet the needs of the particular research project. The focus of this study (undertaken by the first, second, and last authors and colleagues) (McCluskey et al 2011) was an exploration of work participation outcomes in patients with chronic low back pain, a leading cause of work disability in the United Kingdom (Health and Safety Executive 2007). …”

“…In response to calls in the literature for more qualitative research to provide better insight into psychosocial obstacles to recovery and work participation for those with back pain (Nicholas 2010;Wynn & Money 2009), we undertook an exploratory interview study using the CSM to ask patients about their back pain in relation to work participation outcomes (see McCluskey et al 2011). A novel aspect to this research was our inclusion of those close to patients-their "significant others"-to allow for an exploration of the wider social influences on work participation for those with back pain.…”

‘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

“…Or, does the proposed increase in relationship strength as a result of empathic responses from significant others buffer the negative effects on the relationship due to one partner having CMP? Complexity can also arise when this support or empathic response, viewed by couples as an indicator of relationship strength, translates into solicitousness which has a potentially detrimental effect on pain outcomes [8,[28][29][30]. It has also been suggested that by providing help with everyday tasks, significant others are reducing the amount of activities for the person with pain, leaving more time for them to focus/ruminate on their condition.…”

“…Several studies have proposed that significant others can reinforce an individual's unhelpful pain cognitions, such as fear of movement, catastrophizing thoughts about pain and recovery, mistaken beliefs about the nature of pain, pessimistic beliefs regarding the outcome of treatment, and the unlikelihood of returning to work [3][4][5][6]. It has also been shown that potentially detrimental pain behaviors, such as over-use of pain medication, disturbed gait or limping, unduly resting/lying down, seeking compensation, or absence from work, can persist due to the overly-solicitous and/or negative responses of significant others [7][8][9].…”