Narratives of life with long-term low back pain: A follow up interview study.

BACKGROUND: Long-term low back pain is associated with multiple challenges to a person's identity and social position. Despite efforts to understand the challenges of low back pain, recovery remains a major problem both personally and socially. This indicate a need for a different approach. Although personal stories have been used to extend knowledge of issues that relate to low back pain, they also make it possible to learn about how people understand themselves and their lives. As such, analysis of narratives may provide further insights into people's coping processes and novel insights about how best to support them. OBJECTIVE: The aim of the study was to analyse personal recovery narratives to gain an insight into how people understand themselves and cope with long-term low back pain 2-4 years after a bio-psycho-social counselling intervention. STUDY DESIGN: Using a Ricoeurian phenomenological-hermeneutic perspective, qualitative in-depth interviews were undertaken and interpreted to explore people's narratives of long-term recovery after an intervention. METHODS: We interviewed 25 informants 2-4 years after participating in a counselling intervention for low back pain where they were advised to exercise regularly; they were part of the intervention group in a randomised clinical trial. The sample included both informants who had benefited from the intervention and some who had not. Analysis was informed by Ricoeur's interpretation theory. FINDINGS: The informants' stories revealed two main narratives regarding themselves and their lives: (1) getting on with life without pain, (2) life with continual pain and variations of the emplotment. The first included Recovering from low back pain and returning to prior lifestyle if possible, Keeping low back pain in check by strict regimes, or Developing strategies when low back pain recurs. The second related to Finding a way to a functioning everyday life with continual pain while narratives of being stuck with low back pain and finding no way out highlight the significance of being able to configure a narrative that can support an understanding of the pain and how to deal with it to have a functioning life. Furthermore, the health professional has a significant role to play in the configuration of narratives. CONCLUSIONS: The challenge for people with low back pain was to find ways of getting on with life, and this included their ability to configure an understandable narrative that opened up for a future, implying new understandings of the self and how life could be lived. When healthcare professionals offered personal and realistic suggestions to the informants' configuration of narratives of life with low back pain, they supported a positive change in the informants' ways of coping with their situation. IMPLICATIONS: Health professionals can play an important role in low back pain sufferers' configuration of meaningful narratives that help in coping with pain and learning about the relationship between pain and everyday life.

Low back pain patients' beliefs about effective/ineffective constituents of a counseling intervention: a follow-up interview study.

PURPOSE: Everyday activities are important factors for avoiding the development of chronic low back pain (LBP). The purpose this study was to explore LBP patients' perspective on long-term effects of participating in a counseling intervention designed to motivate them to change work routines and to exercise. METHOD: Follow-up qualitative study. Semi-structured interviews were made of 25 LBP patients who had received the counseling intervention. Interviews were transcribed and explored with an interpretative thematic analysis. The findings were organized around Kleinman's conception of "explanatory models". RESULTS: For the individual participant the beliefs about the illness were internally coherent, but most often they were idiosyncratic and fitted to the particular participants' overall explanatory model. Participation in the counseling intervention had created a sense of certainty and potential control over the disease and had legitimized their sick role at work and at home. The majority of the patients reported having integrated exercise into their explanatory models and understood exercise to be beneficial in their continual and concrete management of their LBP. CONCLUSIONS: The intervention had affected the patients' personal agency and space for action. We suggest that this effect was linked to the individually tailored approach drawing on both educational and motivational agents. IMPLICATIONS FOR REHABILITATION: Maintaining everyday activities, including retaining one's occupation, is an important factor in low back pain rehabilitation. Counselling on low back pain rehabilitation must be aligned with people's beliefs about their illness. A counselling intervention made patients adopt exercising into their long-term management of low back pain.

Patients' interpretations of a counselling intervention for low back pain: a narrative analysis.

BACKGROUND: Low back pain often becomes a chronic condition and causes physical, psychological, social, and occupational impairment. Despite huge allocations of resources into the healthcare system and the labour market for treating and preventing low back pain, problems related to low back pain persist. A Danish randomised controlled trial identified an effective counselling intervention on low back pain patients' physical function, bodily pain and sick leave. Counselling addressed experienced workplace barriers and physical activity. OBJECTIVE: The objective of the present study was to achieve a deeper understanding of how the patients interpreted the explanatory resources that were made available to them during the intervention, and how they integrated these resources into their personal biographies. DESIGN: The present study was a qualitative analysis of a purposive sample of transcripts of status interviews performed during the randomised controlled trial's intervention. ANALYSIS: Between two individual counselling sessions, all 110 participants were interviewed about their perspectives on adhering to their individual plans for reaching specific goals for adjustments at their workplace and for enhancing physical activity. These plans were developed and agreed upon by the participants and the counsellor. A sample (n=20) of these interviews was analysed in the present study using the three steps in Ricoeur's method for text analysis. Bury's concept of chronic illness as a biographical disruption was used as a theoretical framework for further interpretations of the dataset. RESULTS: The participants valued the counsellor's open inquiry into the problems they had with their back. The participants' active engagement in creating new explanatory systems was crucial for their benefits from the intervention. If participants managed to change their health behaviour, it assisted them in transforming from being passive victims of pain into becoming active and in control. Participants who did not feel that they were sufficiently able to adhere to the treatment plan felt increasingly stigmatised, because they understood themselves to be in a position of disgrace in their own eyes and in the eyes of the system that offered them help. CONCLUSION: The counsellor's assistance in crafting the first possible and manageable steps towards returning to work and enhancing exercising supported the participants' commitment to the treatment plan.