Welcome back to Spine IQ’s Back Blog! This week, we would like to discuss a complex topic that is recommended by every clinical practice guideline as treatment or goal for low back pain: self-management.1,2 Low back pain is thought to effect 80% of people at some point in their life and commonly reoccurs. In fact, two-thirds of people with an episode of low back pain report flare-ups within one year. While having the confidence, knowledge, and self-efficacy to self-manage low back pain can be extremely important, patients attitudes towards self-management has not been explored until recently. Bourke et al. conducted qualitative interviews to explore the perspectives of patients with chronic low back pain on self-management. This blog will summarize these clinically relevant findings.3
Qualitative semi-structured interviews of 9 patients with chronic low back pain were analyzed. The interviews were transcribed and analyzed for common themes. Open-ended questions allowed exploration of the patients experiences and thoughts in their own words.
Six primary themes were found: self-doubt, independent discovery, coping, resilience, opportunity and threat, and living with pain differently. Patients had increased self-doubt during flare-ups, which was correlated with losing a sense of control and feeling the need to search for an explanation or cure. All patients felt that learning self-management strategies led to an independent discovery of their own self-efficacy. Over time patients learn strategies regarding how to cope with low back pain on a day-to-day basis which help them feel resilient instead of vulnerable and able to continue to engage in valued activities. Seeking healthcare was seen as a mixed opportunity and threat for patients. For some, the healthcare professional increased their self-doubt and described low back pain as something to fear. For others, the healthcare professionals reassured them and helped them learn new strategies to self-manage their low back pain.
Qualitative research allows us to learn about the lived experiences of patients. These rigorous analyses of interviews are important to better understand how patients feel about self-management of chronic low back pain. Patients seem to have the ability to self-manage and feel resilient about their bodies, however, it is critical that the healthcare professional plays a positive role in this effort. Just like low back pain, the perceived ability to self-managealso fluctuates. Even for patients that have high self-efficacy, good coping skills, and some self-management strategies, episodes of pain may allow self-doubt to creep back in and they decide to seek care. Healthcare professionals should not see this as a failure of previous self-management interventions but instead as an opportunity to help patients become resilient and independent once again. It is imperative that the clinician recognize the successes of patients who “work through” the pain and memorialize the date so that when the next episode comes, there will be a positive history to demonstrate to that patient that they can overcome their pain once again. In previous Back Blogs, we have discussed (1) guidance on self-management, (2) how to build successful self-management plans, (3) barriers and facilitators to supporting self-management. Make sure to read those for some tips on how to better encourage self-management for your low back pain patients.
- National Guideline Centre (UK). Low Back Pain and Sciatica in Over 16s: Assessment and Management. National Institute for Health and Care Excellence (UK); 2016. Accessed June 11, 2021. http://www.ncbi.nlm.nih.gov/books/NBK401577/
- Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367
- Bourke MJ, Ferguson D, Cooke M. Patient Experiences of Self-Management for Chronic Low Back Pain: A Qualitative Study. Phys Ther. Published online March 30, 2022:pzac030. doi:10.1093/ptj/pzac030