Background
Methods
Study design
Participant selection
Age (years) | |
Mean ± SD | 43.2 ± 12.05 |
Gender
| |
Female | 74.6% |
Male | 25.4% |
Country
| |
Australia | 98.5% |
Other | 1.5% |
State
| |
Queensland | 56.9% |
New South Wales | 16.9% |
Victoria | 15.4% |
Other | 10.8% |
LBP everyday
| |
Yes | 82% |
No | 18% |
Time frame of LBP variation
| |
Daily | 55.4% |
Weekly | 23.1% |
Monthly | 7.7% |
Other | 13.8% |
Periods of no LBP
| |
Yes | 29.7% |
No | 70.3% |
Data collection/procedure
Methodology and theoretical underpinnings
Data analysis
Results
Analysis of responses to question 1
Discourse (pattern of thinking) | Explanation |
---|---|
1) Body as machine | The body is viewed as biomechanical (literally: the body as a machine) or anatomical. Like a machine, the body is considered to be able to break and can sometimes be repaired. LBP persists because something is physically defective. |
2) LBP as permanent/immutable | Related to the first discourse, LBP is conceptualised as a static or fixed entity that once ‘broken’, it cannot be ‘fixed’. LBP is not dynamic or fluid but unchangeable and permanent. |
3) LBP is complex | This is a counter discourse to the first two. Multiple factors can contribute to the persistence of LBP – not only biomechanical or anatomical but also possibly psychosocial or cultural factors. There is no simple explanation for ongoing LBP. |
4) LBP is very negative | LBP is conceptualised as abnormal, catastrophic, or very negative experience. LBP should be avoided and/or has a large effect on life. |
Discourse 1: Body as machine
And participant 59 wrote:“Degeneration of the integrity of my tendons and ligaments from faulty collagen due to Ehlers-Danlos Syndrome causing instability in my spine (and other joints) resulting in herniation of spinal discs (currently 3 cervical, 1 thoracic and 2 lumbar) and degenerative disc disease at L5/S1. Also sacroiliac joint dysfunction, hip dysplasia and instability has a correlating impact to my back issues.”
Like these participants, many used technical biomedical language, for example: “fusion surgery leading to sacroiliac joint problems” P8, “my L4 and L5 are rubbing together” P43, and “spondylolisthesis L5S1 with pars defect” P62. Others spoke less specifically of general physical conditions (e.g., “spinal damage caused by arthritis” P7).“My motor control has suffered due to chronic low back pain initially caused by an injury and then perpetuated by degeneration in the joints. Even though there is no acute injury any more (arthritis is still there), my motor patterns are inefficient and I recruit larger muscles to stabilise my back due to pain inhibition. This means sometimes I do movements that are actually more forceful that needed and increase joint loading at the degenerating level, which is what causes a flare up.”
Discourse 2: LBP as permanent/immutable
“I am suffering from multi-level degenerating disks. (L1-S1) There is no "mechanical fix" for my condition. And as time goes by it continues to degenerate.” P105
Discourse 3: LBP is complex
This participant highlights a complex interplay between biological, psychological and emotional contributing factors to his condition: while LBP may have an anatomical driver of a fractured vertebra, he believed his LBP was also impacted by the interplay of psychological health (depression), mood (anger) and pain beliefs (acceptance).“I have a severe burst dispersion fracture of L1 with up to 75% of the body of L1 crushed and dissolved. I have no neurological impairment and the fracture was stabilised without surgery. In 2013 I had a 20-year MRI and consulted a private pain specialist (also ortho surgeon) and he confirmed that the root cause is mechanical. My background pain was very high for approx 1 year (mid 2012-13) during a suicidal depression period. I have several month long bouts of depression every 3-5 years but the 2012 episode was worse than others. This fed the pain which fed the depression and I started hating my pain for the first time in 22 years. Although it can be tiring and exasperating at times, I had never hated the pain or wished it gone. Interestingly, during a few months of intense psychological treatment sessions, I had a week and a half long bad pain episode but it wasn't until the 4th day that I realised that my attitude to the pain and my "automatic responses" to it had reverted back to my usual acceptance so I saw that as a step forward. The year highlighted again the direct correlation of mood to pain.”
Two participants (P71 and P13 – both quoted above) only stated a complex picture of their condition without any aspect of the first two discourses (‘body as machine’ or ‘body as permanent’).“I don't really know [why my pain is ongoing or recurrent]. I do believe that there's a "learned behaviour" in my brain. I have been trying to focus on different things lately or visualise different things when my back starts to get worse, and it seems to be helping a bit. I have recently gone back to the gym and have found that I can move and perform some exercises that not only are pain free but help with my overall pain. That has shown me that movement is not the cause of my pain, but the type of movement and how I do it.” P71
Discourse 4: LBP is very negative
Analysis of responses to question 2
Health Care Provider n (%) | Internet n (%) | Family n (%) | Friends n (%) | Other* n (%) |
---|---|---|---|---|
116 (89) | 31 (24) | 12 (9) | 7 (5) | 16 (12) self-reflection 9 (7) education 4 (3) scientific lit 3 (2) other 1 (1) not relevant |
33 (25) Total
|
Discussion
This participant used all four discourses – but some are stronger than others. The participant speaks first about biomechanical/anatomical factors as reasons for the ongoing nature of their LBP (“degenerated vertebra and discs”, “pinching of nerves”, “soft tissue damage”) using very definite language “there is…results in… a lot of…”. This language suits the dominant form of understanding bodies and health in biomedicine: bodies are like machines that may or may not be fixed. Like a machine, when something cannot be ‘fixed’ it is ‘permanently broken’. Notably, the participant also provides another less definite story (“it is said that...”). This choice of wording makes the subsequent statement appear not to be coming from her/his own thinking, perhaps indicating the participant has heard this information but does not really believe/understand it. In this second story, the participant discusses that LBP can persist because a number of factors can influence it (the participant mentions psychological and other physical conditions). Although the traditional view is given more emphasis, the presence of both stories suggests this person is able to adopt more than one perspective – an understanding of LBP as complex and not only biomechanical or anatomical. Such participants show an ability to integrate biopsychosocial with biomedical understandings. As other research has highlighted that sense-making processes may play a role in developing harmful LBP beliefs [45], this highlights a potentially useful way forward to assist people with LBP (and others) to helpfully reconceptualise their condition.“there is degeneration of vertebra and discs which results in pinching of nerves. A lot of soft tissue damage to core muscles front and back which makes that back more pliable. It is said that my brain is not interpreting the signals properly because of many things including PTSD, TBI, IBS…” P2.