Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter April 29, 2019

What decreases low back pain? A qualitative study of patient perspectives

Jenny Setchell ORCID logo, Nathalia Costa, Manuela Ferreira and Paul W. Hodges

Abstract

Background and aims

This study aimed to determine, from the perspective of individuals living with the condition, what decreases their low back pain (LBP). LBP affects most people at some point during their life. The condition has a meaningful effect on people’s lives including pain, reduced physical and social function, mood fluctuations, and a reduced ability to work. Despite a considerable amount of research on the topic, few strategies to reduce LBP are considered successful, and there has been little investigation into what individuals with the condition believe reduce it. This study aimed to address this gap in the literature by investigating what individuals with the condition believe reduces their LBP.

Methods

We employed a descriptive qualitative design using a custom-built online survey. Participants were 130 adults in Australia who self-identified as having current or having had previous LBP with or without co-morbidities. Data from the survey responses were analysed using content analysis to determine which management approaches participants considered to be effective in reducing their LBP.

Results

Participants most commonly said that they believed their LBP was reduced by: heat/cold (86, 66%), medication (84, 64.1%), and rest (78, 60%). Next most common was activity/exercise (73, 55.7%). Other factors such as consulting a health professional (52, 39.7%), stretching/therapeutic exercise (50, 38.1%), resting from aggravating activities (45, 34.3%), and psychological changes (41, 31.3%) were mentioned, but considerably less often.

Conclusions

Current literature points to the inefficacy of many of the factors participants reported as helping to reduce the effects of their condition, including the treatments that were most commonly listed by the participants in this study, namely: heat/cold, medication and rest. A possible cause of this discrepancy might be that individuals with LBP consider temporary relief (on a scale of hours) to be an acceptable outcome, whereas clinical trials tend to consider efficacy by long term outcomes (on a scale of weeks, months or years).

Implications

There are several implications of this research. From one perspective, there is the implication that public education about efficacious treatments may need to be enhanced as there is a discrepancy between research findings and the perspectives of individuals living with LBP. On the other hand, these findings also suggest that it is timely to re-examine the focus of LBP research to consider outcomes that are valuable to people living with the condition, which this study implies should include short term or temporary effects. The findings may also help clinicians tailor management to suit the individual patients by increasing the awareness that patient and research perspectives may at times diverge.


Corresponding author: Dr. Jenny Setchell, PhD, The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, QLD, Australia, Phone: +61733654506, Fax: +617334687889

Acknowledgements

We thank the participants who contributed their time and experience to this study.

  1. Authors’ statements

  2. Research funding: The study was funded by grants (Program Grant: #1091302; Centre of Research Excellence grant: #1079078) and fellowships (PH – APP1102905; MLF – APP1143593; JS – APP1157199) from the National Health and Medical Research Council (NHMRC) of Australia.

  3. Conflict of interest: There are no conflicts of interest to declare.

  4. Informed consent: Informed consent was required for participation in this study. Participants gave informed consent before participating in this study.

  5. Ethical approval: Institutional approval was sort and gained for this project. Data was handled within institutional guidelines to ensure anonymity of participants in data storage and reporting. As the research was not a clinical trial it was not registered.

References

[1] Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M. What low back pain is and why we need to pay attention. Lancet (London, England) 2018;391:2356–67.10.1016/S0140-6736(18)30480-XSearch in Google Scholar

[2] Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet (London, England) 2017;389:736–47.10.1016/S0140-6736(16)30970-9Search in Google Scholar

[3] Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008;8:8–20.10.1016/j.spinee.2007.10.005Search in Google Scholar

[4] Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010;24:769–81.10.1016/j.berh.2010.10.002Search in Google Scholar

[5] Ricci JA, Stewart WF, Chee E, Leotta C, Foley K, Hochberg MC. Back pain exacerbations and lost productive time costs in United States workers. Spine (Phila Pa 1976) 2006;31:3052–60.10.1097/01.brs.0000249521.61813.aaSearch in Google Scholar

[6] Buchbinder R, Van Tulder M, Oberg B, Costa L, Woolf A, Schoene M, Croft P; Lancet Low Back Pain Series Working Group. Low back pain: a call for action. Lancet 2018;391:2384–8.10.1016/S0140-6736(18)30488-4Search in Google Scholar

[7] Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012;64:2028–37.10.1002/art.34347Search in Google Scholar

[8] Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG; Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet (London, England) 2018;391:2368–83.10.1016/S0140-6736(18)30489-6Search in Google Scholar

[9] Geneen L, Moore R, Clarke C, Martin D, Colvin L, Smith B. Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database Syst Rev 2017:CD011279.10.1002/14651858.CD011279.pub2Search in Google Scholar PubMed PubMed Central

[10] van Duijvenbode I, Jellema P, van Poppel M, van Tulder M. Lumbar supports for prevention and treatment of low back pain. Cochrane Database Syst Rev 2008:CD001823.10.1002/14651858.CD001823.pub3Search in Google Scholar PubMed PubMed Central

[11] Khadilkar A OD, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev 2008:CD003008.10.1002/14651858.CD003008.pub3Search in Google Scholar PubMed PubMed Central

[12] Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev 2010:CD007612.10.1002/14651858.CD007612Search in Google Scholar

[13] Overdevest GM, Jacobs W, Vleggeert-Lankamp C, Thomé C, Gunzburg R, Peul W. Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Cochrane Database Syst Rev 2015:CD010036.10.1002/14651858.CD010036Search in Google Scholar

[14] Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC. Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Database Syst Rev 2013:CD004959.10.1002/14651858.CD004959.pub4Search in Google Scholar PubMed

[15] Delitto A, George S, Van Dillen L, Whitman J, Sowa G, Shekelle P, Denninger TR, Godges JJ. Low back pain: clinical practice guidelines linked to the International Classification of Functioning Disability, and Health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther 2012;42:A1–57.10.2519/jospt.2012.42.4.A1Search in Google Scholar PubMed PubMed Central

[16] National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: Assessment and management (NICE Guideline NG59). Available from: http://www.nice.org.uk/34.guidance/ng59. 2016.Search in Google Scholar

[17] Kawi J. Chronic low back pain patients’ perceptions on self-management, self-management support, and functional ability. Pain Manag Nurs 2014;15:258–64.10.1016/j.pmn.2012.09.003Search in Google Scholar PubMed

[18] Crowe M, Whitehead L, Gagan MJ, Baxter D, Panckhurst A. Self-management and chronic low back pain: a qualitative study. J Adv Nurs 2010;66:1478–86.10.1111/j.1365-2648.2010.05316.xSearch in Google Scholar PubMed

[19] Braun V, Clarke V. Successful qualitative research. London, UK: Sage, 2013.Search in Google Scholar

[20] Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci 2013;15:398–405.10.1111/nhs.12048Search in Google Scholar PubMed

[21] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007;19:349–57.10.1093/intqhc/mzm042Search in Google Scholar PubMed

[22] Australian Institute of Health and Welfare 2016. Australia’s health series no. 15. Cat. no. AUS 199. Canberra: AIHW, 2016.Search in Google Scholar

[23] Maher CG, Williams CM, Lin CW, Latimer J. Managing low back pain in primary care. Aust Prescr 2011;34:128–32.10.18773/austprescr.2011.069Search in Google Scholar

[24] Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G. European guidelines for the management of chronic non-specific low back pain. Eur Spine J 2006;(Suppl 2):S192–300.10.1007/s00586-006-1072-1Search in Google Scholar PubMed PubMed Central

[25] French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database Syst Rev 2006:CD004750.10.1002/14651858.CD004750Search in Google Scholar

[26] Stark J, Petrofsky J, Berk L, Bains G, Chen S, Doyle G. Continuous low-level heatwrap therapy relieves low back pain and reduces muscle stiffness. Phys Sportsmed 2014;42:39–48.10.3810/psm.2014.11.2090Search in Google Scholar PubMed

[27] Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CW, Day RO, McLachlan AJ, Ferreira ML. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: Systematic review and meta-analysis of randomised placebo controlled trials. Br Med J 2015;350:h1225.10.1136/bmj.h1225Search in Google Scholar PubMed PubMed Central

[28] Saragiotto BT, Machado GC, Ferreira ML, Pinheiro MB, Abdel Shaheed C, Maher CG. Paracetamol for low back pain. Cochrane Database Syst Rev 2016:CD012230.10.1002/14651858.CD012230Search in Google Scholar PubMed PubMed Central

[29] Goldberg H, Firtch W, Tyburski M, Pressman A, Ackerson L, Hamilton L, Carver R, Maratukulam A, Won LA, Carragee E, Avins AL. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. J Am Med Assoc 2015;313:1915–23.10.1001/jama.2015.4468Search in Google Scholar PubMed PubMed Central

[30] Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Ann Rheum Dis 2017;76:1269–78.10.1136/annrheumdis-2016-210597Search in Google Scholar PubMed

[31] Enthoven WT, Roelofs PD, Deyo RA, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev 2016;2:CD012087.10.1002/14651858.CD012087Search in Google Scholar PubMed PubMed Central

[32] Setchell J, Costa N, Ferreira M, Makovey J, Nielsen M, Hodges P. Individuals’ explanations for their persistent or recurrent low back pain: a cross-sectional survey. BMC Musculoskelet Disord 2017;18:466.10.1186/s12891-017-1831-7Search in Google Scholar PubMed PubMed Central

[33] Edwards RR, Dworkin RH, Sullivan MD, Turk DC, Wasan AD. The role of psychosocial processes in the development and maintenance of chronic pain. J Pain 2016;17(Suppl):T70–92.10.1016/j.jpain.2016.01.001Search in Google Scholar PubMed PubMed Central

[34] Linton SJ. Occupational psychological factors increase the risk for back pain: a systematic review. J Occup Rehabil 2001;11:53–66.10.1023/A:1016656225318Search in Google Scholar

[35] Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 2000;85:317–32.10.1016/S0304-3959(99)00242-0Search in Google Scholar

[36] Linton SJ. A review of psychological risk factors in back and neck pain. Spine 2000;25:1148–56.10.1097/00007632-200005010-00017Search in Google Scholar PubMed

[37] Vachon-Presseau E, Roy M, Martel MO, Caron E, Marin MF, Chen J, Albouy G, Plante I, Sullivan MJ, Lupien SJ, Rainville P. The stress model of chronic pain: evidence from basal cortisol and hippocampal structure and function in humans. Brain 2013;136(Pt 3):815–27.10.1093/brain/aws371Search in Google Scholar PubMed

[38] Parsons S, Harding G, Breen A, Foster N, Tamar P, Vogel S, Underwood M. The influence of patients’ and primary care practitioners’ beliefs and expectations about chronic musculoskeletal pain on the process of care: A systematic review of qualitative studies. Clin J Pain 2007;23:91–8.10.1097/01.ajp.0000210947.34676.34Search in Google Scholar PubMed

Received: 2019-01-24
Revised: 2019-03-27
Accepted: 2019-03-28
Published Online: 2019-04-29
Published in Print: 2019-07-26

©2019 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.