The good pain patient: a critical evaluation of patients' self-presentations in specialist pain clinics.

Established research supports collaborative patient-clinician communication as a means of improving pain management and decreasing opioid use by patients with chronic pain. However, much of this scholarship emphasises clinicians' capacities to shape and improve communication; limited research investigates patients' roles in this process. Drawing on 40 ethnographic observations of patient-clinician interactions, clinical spaces and case conferences within one specialist pain clinic in Brisbane, Australia, this paper investigates how and why patients present themselves in particular ways within consultations. Our theoretical lens combines concepts from Goffman on patienthood and stigma with Foucauldian theories of pastoral and disciplinary power. Findings suggest that elements of the clinical environment - namely posters - usher patients towards presenting in what we conceptualise as the 'good pain patient' role. In this role, patients demonstrate that they are moral, responsible, and contributing members of society. Yet, such a role is problematic to opening communication, with the role constraining what is socially acceptable for patients with chronic pain to say, do, or feel. In recognising how clinical contexts facilitate problematic good pain patient presentations, this paper directs attention to the spatial and relational nature of implicit clinical expectations and constrained good pain patient presentations.

Unravelling epistemic injustice in medical education: The case of the underperforming learner.

CONTEXT: Epistemic injustice refers to a wrong done to someone in their capacity as a knower. While philosophers have detailed the pervasiveness of this issue within healthcare, it is only beginning to be discussed by medical educators. The purpose of this article is to expand the field's understanding of this concept and to demonstrate how it can be used to reframe complex problems in medical education. METHODS: After outlining the basic features of epistemic injustice, we clarify its intended (and unintended) meaning and detail what is required for a perceived harm to be named an epistemic injustice. Using an example from our own work on introversion in undergraduate medical education, we illustrate what epistemic injustice might look like from the perspectives of both educators and students and show how the concept can reorient our perspective on academic underperformance. RESULTS: Epistemic injustice results from two things: (1) social power dynamics that give some individuals control over others, and (2) identity prejudice that is associated with discriminatory stereotypes. This can lead to one, or both, forms of epistemic injustice: testimonial and hermeneutical. Our worked example demonstrates how medical educators can be unaware of when and how epistemic injustice is happening, yet the effects on students' well-being and sense of selves can be profound. Thinking about academic underperformance with epistemic injustice in mind can reveal an emphasis within current educational practices on diagnosing learning deficiencies, to the detriment of holistically representing its socially constructed and structural nature. CONCLUSIONS: This article builds upon recent calls to recognise epistemic injustice in medical education by clarifying its terminology and intended use and providing in-depth application and analysis to a particular case: underperformance and the introverted medical student. Equipped with a more sophisticated understanding of the term, medical educators may be able to re-conceptualise long-standing issues including, but also beyond, underperformance.

Navigating whiteness: affective relational intensities of non-clinical psychosocial support by and for culturally and linguistically diverse people.

Mental health is political, with intersecting economic, cultural, racialized, and affective dimensions making up the care assemblage, signalling how care is conceptualised and who is deserving of care. In this article, we examine emotions circulating in a non-clinical psychosocial support program for culturally and linguistically diverse people experiencing mental ill-health, foregrounding the relations between culture, race, economy, and assumptions underpinning understandings of care. The mental health program under study offers psychosocial support for culturally and linguistically diverse people to manage life challenges and mental ill-health exacerbated by navigating the complexities of Australia's health and social care systems. We draw on interviews with clients, staff, and providers of intersecting services, employing Ahmed's concept of affective economies and Savreemootoo's concept of navigating whiteness to examine the care assemblage within interview transcripts. We provide insight into affective intensities such as hate, anger, and indifference embedded in white Anglo-centric services, positioning culturally and linguistically diverse people on the margins of care. Non-clinical psychosocial support programs can counter such affective intensities by training and employing multicultural peer support workers-people with lived experience-prioritising relational and place-based approaches to care and supporting and providing clients with relevant skills to navigate an Anglo-centric care system. However, this support is filled with affective tensions: (com)passion, frustration and fatigue circulate and clash due to the scarcity of resources, further signalling what type of care (and with/for whom) is prioritised within Australian relations of care.

Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia.

OBJECTIVES: Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity - the ability to examine and challenge power relations, and broader social issues embedded in everyday life - can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers. METHODS: Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia - a private physiotherapy clinic and a public multidisciplinary pain clinic. RESULTS: Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices - such as assisting patients to navigate health care systems, considering patients' socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities. CONCLUSIONS: Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.

'Engaging on a slightly more human level': A qualitative study exploring the care of individuals with back pain in a multidisciplinary pain clinic.

Chronic low back pain is characterised by multiple and overlapping biological, psychological, social and broader dimensions, affecting individuals' lives. Multidisciplinary pain services have been considered optimal settings to account for the multidimensionality of chronic low back pain but have largely focused on cognitive and behavioural aspects of individuals' pain. Social dimensions are usually underexplored, considered outside or beyond healthcare professionals' scope of practice. Employing Actor Network Theorist Mol's concept multiplicity, our aim in this paper is to explore how a pain service's practices bring to the fore the social dimensions of individuals living with low back pain. Drawing on 32 ethnographic observations and four group exchanges with the service's clinicians, findings suggest that practices produced multiple enactments of an individual with low back pain. Although individuals' social context was present and manifested during consultations at the pain service (first enactment: 'the person'), it was often disconnected from care and overlooked in 'treatment/management' (second enactment: 'the patient'). In contrast, certain practices at the pain service not only provided acknowledgement of, but actions towards enhancing, individuals' social contexts by adapting rules and habits, providing assistance outside the service and shifting power relations during consultations (third enactment: 'the patient-person'). We therefore argue that different practices enact different versions of an individual with low back pain in pain services, and that engagement with individuals' social contexts can be part of a service's agenda.

"Their Happiness, Not Neurotypical Success": Autistic Adults Reflect on the Parenting of Autistic Children.

PURPOSE: Parenting has implications for psychosocial adjustment well into adulthood. While much is known about the parenting behaviors that influence adjustment in autistic children, little is known about how the effects of parenting persist in autistic adults. Further, autistic adults' perspectives on how they were parented have not been investigated to date. This study aimed to examine autistic adults' perspectives on their experiences of being parented in childhood and the advice they would like to offer to parents of autistic children in the context of their lived experience. METHODS: Ninety-six Australian autistic adults responded to open-ended questions in a larger survey assessing childhood experiences of being parented, adult attachment, psychological flexibility, and adult adjustment. RESULTS: A total of 10 themes were identified. Autistic adults emphasized the importance of embracing early diagnosis and that the goal of parents should be their child's happiness rather than "neurotypical" success. They highlighted the importance of unconditional love and understanding of their autistic child, recognizing that autistic children have similar fundamental needs as other children. Participants discussed the importance of structure and predictability in the home to feelings of safety. Parents were encouraged to meet them halfway. Finally, autistic adults reflected on the role of parents in advocacy and parental well-being. Parental neurodivergence was discussed as a possible bane or boon. CONCLUSIONS: Autistic adults emphasized the importance of unconditional acceptance from their parents, with the goal being their child's happiness. Findings from this study will inform future programs for families of autistic children.

Distress in the care of people with chronic low back pain: insights from an ethnographic study.

Introduction: Distress is part of the experiences and care for people with chronic low back pain. However, distress is often pathologised and individualised; it is seen as a problem within the individual in pain and something to be downplayed, avoided, or fixed. To that end, we situate distress as a normal everyday relational experience circulating, affecting, moving in, through, and across bodies. Challenging practices that may amplify distress, we draw on the theorisation of affect as a relational assemblage to analyse physiotherapy clinical encounters in the care of people with chronic low back pain. Methods: Adopting a critical reflexive ethnographic approach, we analyse data from a qualitative project involving 15 ethnographic observations of patient-physiotherapist interactions and 6 collaborative dialogues between researchers and physiotherapists. We foreground conceptualisations of distress- and what they make (im)possible-to trace embodied assemblage formations and relationality when caring for people with chronic low back pain. Results: Our findings indicate that conceptualisation matters to the clinical entanglement, particularly how distress is recognised and navigated. Our study highlights how distress is both a lived experience and an affective relation-that both the physiotherapist and people with chronic low back pain experience distress and can be affected by and affect each other within clinical encounters. Discussion: Situated at the intersection of health sociology, sociology of emotions, and physiotherapy, our study offers a worked example of applying an affective assemblage theoretical framework to understanding emotionally imbued clinical interactions. Viewing physiotherapy care through an affective assemblage lens allows for recognising that life, pain, and distress are emerging, always in flux. Such an approach recognises that clinicians and patients experience distress; they are affected by and affect each other. It demands a more humanistic approach to care and helps move towards reconnecting the inseparable in clinical practice-emotion and reason, body and mind, carer and cared for.

Inverse Miniemulsion Enables the Continuous-Flow Synthesis of Controlled Ultra-High Molecular Weight Polymers.

We report the controlled synthesis of ultra-high molecular weight (UHMW) polymers (Mn ≥ 106 g/mol) via continuous flow in a tubular reactor. At high monomer conversion, UHMW polymers in homogeneous batch polymerization exhibit high viscosities that pose challenges for employing continuous flow reactors. However, under heterogeneous inverse miniemulsion (IME) conditions, UHMW polymers can be produced within the dispersed phase, while the viscosity of the heterogeneous mixture remains approximately the same as the viscosity of the continuous phase. Conducting such IME polymerizations in flow results in a faster rate of polymerization compared to batch IME polymerizations while still providing excellent control over molecular weight up to 106 g/mol. Crucial emulsion parameters, such as particle size and stability under continuous flow conditions, were examined using dynamic light scattering. A range of poly(N,N-dimethylacrylamide) and poly(4-acryloylmorpholine) polymers with molecular weights of 104-106 g/mol (D ≤ 1.31) were produced by this method using water-soluble trithiocarbonates as photoiniferters.

"I felt uncertain about my whole future"-a qualitative investigation of people's experiences of navigating uncertainty when seeking care for their low back pain.

ABSTRACT: Uncertainty pervades low back pain (LBP). This study aimed to explore individuals' experiences of navigating uncertainty when seeking care for their LBP, with a view to better understanding the contexts in which they experience uncertainty and gaining insight into how uncertainty may be better navigated during clinical encounters. We conducted 15 semistructured interviews with people who have experienced LBP. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Analysis produced 4 themes. To reflect the unsettled nature of participants' discussions of navigating uncertainty, themes are framed as questions: (1) What will happen over time?; (2) Can clinicians help me? Are they willing to?; (3) What are clinicians talking about?; and (4) Am I being taken seriously? Participants also discussed how clinicians could better navigate these uncertainties. Suggestions included making time to (actively) listen to, and acknowledge, patients' concerns; asking open-ended questions; being honest about uncertainty; creating management plans and returning to them; challenging assumptions; remaining curious about patients' context; and providing guidance on how to manage LBP rather than simply giving certainty that symptoms will worsen, lessen, or continue. These findings indicate that many of the uncertainties individuals with LBP experience are intertwined with relational aspects of their interactions with clinicians. Clinicians therefore may need to consider these broader and relational aspects of care when navigating uncertainty with people who experience LBP, bringing attention to the importance of drawing from knowledge produced outside of the usual hierarchy of evidence (eg, systematic reviews and randomised controlled trials).

Quality of life beyond measure: Advanced cancer patients, wellbeing and medicinal cannabis.

Experiences of advanced cancer are assembled and (re)positioned with reference to illness, symptoms and maintaining 'wellbeing'. Medical cannabis is situated at a borderline in this and the broader social domain: between stigmatised and normalised; recreational and pharmaceutical; between perception, experience, discourse and scientific proof of benefit. Yet, in the hyper-medicalised context of randomised clinical trials (RCTs), cancer, wellbeing and medical cannabis are narrowly assessed using individualistic numerical scores. This article attends to patients' perceptions and experiences at this borderline, presenting novel findings from a sociological sub-study embedded within RCTs focused on the use of medical cannabis for symptom relief in advanced cancer. Through a Deleuzo-Guattarian-informed framework, we highlight the fragmentation and reassembling of bodies and propose body-situated experiences of wellbeing in the realm of advanced cancer. Problematising 'biopsychosocial' approaches that centre an individualised disconnected patient body in understandings of wellbeing, experiences of cancer and potential treatments, our findings foreground relational affect and embodied experience, and the role of desire in understanding what wellbeing is and can be. This also underpins and enables exploration of the affective reassembling ascribed to medical cannabis, with particular focus on how it is positioned within RCTs.

The VOTIS, part 2: Using a video-reflexive assessment activity to foster dispositional learning in interprofessional education.

Effective interprofessional collaborative practice (IPCP) requires a new way of working characterized by distributed leadership skills, shared decision-making, and the adoption of uniprofessional and interprofessional identities. Health professional educators are tasked with preparing clinicians for IPCP through interprofessional education (IPE). Numerous IPE teaching interventions have been developed, ranging in length from hours to semesters, designed to introduce students to interprofessional ways of working - usually evaluated in terms of student satisfaction, perceptions of other disciplines and conceptual knowledge. However, working interprofessionally also requires integrating dispositional knowledge into one's emerging interprofessional habits and values. In this paper, we describe a learning activity, inspired by a new video-reflexive methodology, designed to foster dispositional learning of interprofessional skills using a video-based assessment tool: the Video Observation Tool for Interprofessional Skills (VOTIS). Based on focus group and interview data, we suggest the activity's usefulness in fostering conceptual, procedural and dispositional knowledge, as well as reflexive feedback literacy. Overall, our qualitative evaluation of the VOTIS suggests the merits of drawing on video-reflexive methodology and pedagogical theory to re-imagine IPE as a dynamic process, requiring the development of interprofessional skills that must be appropriated into students' emerging (inter)professional identities.

The VOTIS, part 1: development and pilot trial of a tool to assess students' interprofessional skill development using video-reflexive ethnography.

This paper explores the development and evaluation of the video Observation Tool for Interprofessional Skills (VOTIS). We describe the development of an authentic interprofessional assessment tool that incorporates video reflection and allows formative and summative assessment of individual learners' interprofessional skills within an authentic interprofessional context. We then investigate its validity and reliability. The VOTIS was developed using a modified Delphi technique. The tool was piloted with 61 students and 11 clinical educators who completed the VOTIS following team meetings where students interacted about their interprofessional clinical work. The following were calculated: internal consistency; students' proficiency levels; inter-rater reliability between students and clinical educators; and inter-rater reliability between clinical educators and an independent rater. Results indicate that the VOTIS has acceptable internal consistency and moderate reliability and has value in evaluating students' interprofessional skills. Study outcomes highlight the need for more explicit wording of tool content and instructions and further clinical educator training to increase the utility and reliability of the VOTIS as a learning and assessment tool.

Imperatives of health or happiness: Narrative constructions of long-term smoking after undergoing lung screening.

Tobacco control policies reinforce a health imperative that positions citizens as duty-bound to manage their health by abstaining from or quitting smoking. Limited attention is paid to the repercussions - especially for lung screening - of anti-smoking rhetoric emphasising individual responsibility. Drawing on interviews with 27 long-term smokers involved in an international lung screening trial, this study analysed Australian smokers' narratives of smoking. By attending to stigma and the use of public health rhetoric within personal narratives, we show how narratives underscoring individual responsibility for quitting were layered with conflicting explanations of biological responsibility and normative expectations. Ironically, narratives of individual responsibility potentially undermine smoking cessation. In positioning smokers as responsible for their own healthy choices, such rhetoric also positions smokers as responsible for managing their emotional health, which some did through smoking. Thus, anti-smoking campaigns pit the neoliberal imperative of health against the happiness imperative. These findings have implications for the design and delivery of lung screening campaigns. They also support calls to move beyond health messaging emphasising individual choice, towards acknowledging the moral power of structures and public health campaigns to discipline citizens in unintended ways.

'What price do you put on your health?': Medical cannabis, financial toxicity and patient perspectives on medication access in advanced cancer.

INTRODUCTION: Following 2016 legislation permitting limited access to cannabis for research and medicinal purposes, the number of randomized clinical trials (RCTs) investigating the effectiveness of medicinal cannabis (MC) on symptom burden relief in cancer contexts has increased in Australia. This study aimed to understand the perceptions, hopes and concerns of people with advanced cancer regarding the future availability and regulation of MC in Australia. METHODS: This qualitative study draws on semistructured interviews conducted between February 2019 and October 2020 in Brisbane, Australia, as part of an MC RCT substudy. Interviews were undertaken on 48 patients with advanced cancer in palliative care eligible to participate in an MC trial (n = 26 participated in an RCT; n = 2 participated in a pilot study; n = 20 declined). Interviews included a discussion of patients' decision-making regarding trial participation, concerns about MC and perceptions of future availability, including cost. Transcribed interviews were analysed inductively and abductively, informed by constructivist thematic analysis conventions. RESULTS: Overall, participants supported making MC legally accessible as a prescription-only medication. Fear of financial toxicity, however, compromised this pathway. Steep posttrial costs of accessing MC prompted several people to decline trial participation, and others to predict-if found effective-that many would either access MC through alternative pathways or reduce their prescribed dosage to enable affordable access. CONCLUSIONS: These findings suggest that-despite a relatively robust universal healthcare system-Australians are potentially vulnerable to and fearful of financial toxicity. Prevalent in the United States, financial toxicity occurs when disadvantaged cancer patients access necessary but expensive medications with lasting consequences: bankruptcy, ongoing anxiety and cancer worry. Interview transcripts indicate that financial fears-and the systems sustaining them-may pose a threat to RCT completion and to equitable access to legal MC. Such findings support calls for embedding qualitative substudies and community partnerships within RCTs, while also suggesting the importance of subsidisation to overcoming injustices. PATIENT OR PUBLIC CONTRIBUTION: A patient advisory committee informed RCT design. This qualitative substudy foregrounds patients' decision-making, perceptions and experiences.

Towards an ethical multiplicity in low back pain care: Practising beyond the biopsychosocial model.

The biopsychosocial model is currently considered by most researchers and clinicians to be the best approach to low back pain (LBP) care. The model was popularised in LBP care in response to some clear deficiencies in earlier biomedical approaches and is now widely recommended in clinical guidelines and policy statements. Yet the biopsychosocial approach has also been critiqued for its narrow conceptualisation and application. In this article, we explore how attending to the multidimensionality of LBP in practice goes beyond a biopsychosocial approach. We engaged with 90 ethnographic observations of clinical practices, 22 collaborative dialogues with clinicians, and eight consultatory meetings with people with experience of LBP to consider the sociomaterialities of clinical practices in two settings: a private physiotherapy practice and a public multidisciplinary pain clinic. Drawing on the work of Annemarie Mol and Rosi Braidotti, our analyses suggest that sociomaterial practices, involving human and non-human actors, produced multiple objects of clinical attention and ethical concerns about how to attend to this multiplicity well. We argue that the multiplicity of LBP is attended well by reimagining: (1) clinical settings as 'becoming more-than-sterile environments' where objects, furniture and elements such as tears and laughter help to provide a relational, welcoming and comfortable space to all bodies with LBP; (2) differences through 'becoming minoritarian' where considering power relations allows actions towards connectiveness and belonging; and (3) disciplinary boundaries through 'becoming interdisciplinary within' where actions expand traditional scopes of practice. The flux of these multiple becomings moves clinical practice and conceptualisations beyond the biopsychosocial approach to consider a new ethico-onto-epistemological approach to LBP care. They invite clinical practices that engage with an ethical multiplicity of LBP care, providing a better understanding of how places, objects, emotions, power, bodies and professions are interconnected and come together in everyday practice.

Medicinal cannabis in palliative medicine: lessons learnt from randomised controlled trials.

OBJECTIVES: To detail important lessons learnt while conducting several large, medicinal cannabis (MC) randomised clinical trials in a palliative cancer population. METHODS: Investigators involved in these trials had several meetings to agree on the major lessons learnt and how the various challenges could be mitigated in the future. RESULTS: The lessons were sorted into separate categories: patient confidentiality, family dynamics, driving, cost, unfounded beliefs, accessing specific MC products, trial funding, telehealth and COVID-19, and miscellaneous issues. CONCLUSION: Using MC as the intervention arm in such trials entails some unique regulatory, logistical and other challenges. This short report presents key lessons learnt in conducting these randomised controlled trials in a palliative care population for the benefit of future investigators planning similar trials in a similar patient population.

Law Enforcement and Community Provision of Fentanyl Test Strips to People Who Use Drugs for Engagement and Referral to Services.

Use of fentanyl test strips (FTS) to test illicit drugs has been shown to be an effective harm-reduction tool for raising awareness of fentanyl risks, increased self-efficacy to prevent overdose, and safer use behavior changes. From March to June 2020, a total of 6 Massachusetts municipal police departments piloted FTS kit distribution during post-overdose outreach visits, community outreach, and related programming. The Police Assisted Addiction and Recovery Initiative developed the kits, trained departments, and oversaw implementation. The pilot evaluation involved site observations, process measures, and interviews with staff and kit recipients. For every kit distributed, there was approximately 1 health or support service or referral provided; 320 kits were distributed. Key themes from interviews were conceptualizing FTS as a tool, collaborations, and adaptations. Police departments that partnered with community programs amplified project reach. FTS distribution is a simple yet powerful tool that community providers and police can offer alongside linkage to care services and engagement with people who use drugs and their family and friends.

Implementation and Uptake of the Massachusetts Drug Supply Data Stream: A Statewide Public Health-Public Safety Partnership Drug Checking Program.

CONTEXT: The illicit drug supply is rapidly evolving. Equally important to gathering drug supply data for monitoring is timely sharing of information with people who use drugs, the providers who care for them, law enforcement partners, and public health stakeholders so that efforts to avoid harmful substances, take preventive actions, and better target interventions can occur. PROGRAM: The Massachusetts Drug Supply Data Stream (MADDS) is the country's first statewide community drug checking program. Founded on public health-public safety partnerships, MADDS collects remnant drug packaging and paraphernalia with residue from people who use drugs and noncriminal samples from partnering police departments. MADDS tests samples using simultaneous immunoassay fentanyl test strips, Fourier-transform infrared spectrometry (FTIR), and off-site laboratory testing by gas chromatography-mass spectrometry (GC/MS). Results are accessible to community programs and municipalities, while trend analyses inform public health for cross-site alerts and informational bulletins. IMPLEMENTATION: MADDS was launched statewide in 2020 and rapidly expanded to a multisite program. Program staff approached communities and met with municipal police and community partners to secure written agreements to host drug checking. Community partners designed sample collection consistent with their pandemic era workflows. Consultations with stakeholders gathered feedback on design and deliverables. EVALUATION: The program tests sample donations on-site from community agencies and police departments, incorporates review by a medical toxicologist for health and safety concerns, crafts stakeholder-specific communications, and disseminates English, Spanish, and Portuguese language materials. For 2020, a total of 427 samples were tested, of which 47.1% were positive for fentanyl. By early 2021, MADDS detected shifts in cocaine purity, alerted communities of a new toxic fentanyl analogue and a synthetic cannabinoid contaminant, and confirmed the increase of xylazine (a veterinary sedative) in Massachusetts. DISCUSSION: Community drug checking programs can be collaboratively designed with public health and public safety to generate critical health and safety information for people who use drugs and the communities where they live.

The ubiquity of uncertainty in low back pain care.

Despite clinicians being important actors in the context of uncertainty, their experiences navigating uncertainty remain largely unexplored. Drawing on a theory-driven post-qualitative approach, we used Mol's logic of choice/care as a lens through which we made sense of interviews with 22 clinicians who work with patients who experience low back pain (LBP). Our analysis suggests that uncertainty is ubiquitous in LBP care and not limited to particular domains. Clinicians navigated uncertainty when considering patients' personal and social contexts; making therapeutic decisions; navigating emotions and mental health; communicating with, and educating, patients, among others. These uncertainties are intertwined with clinical aspects such as treatment choices and evidence-based education about LBP. At times, clinicians resolved these uncertainties by producing certainty at the cost of attending to human aspects of care. We argue that epistemic shifts, theorisation and practical engagement with theory in training, research and clinical practice may prompt clinicians to embrace uncertainty and enact the logic of care.