Talking about the pain: A patient-centered study of low back pain in primary care

Jeffrey Borkan, Shmuel Reis, Doron Hermoni, Aya Biderman

Research output: Contribution to journalArticlepeer-review

137 Scopus citations

Abstract

Despite considerable research, low back pain (LBP) often proves resistant to treatment. This study was designed to increase the understanding of low back pain through access to patients' perceptions, beliefs, illness behaviors and lived experiences. The findings are based on focus groups, individual interviews and participant observation conducted in primary care practices and community settings in three regions in Israel. Inclusion criteria for the interviews and groups include age greater than 18 years and a history of at least one episode of LBP. Seventy-six LBP subjects between the ages of 18 and 67 (mean 39.5) participated, 65% male and 35% female. The analytic method is content analysis, consisting of a formal, multi-step process designed to elucidate inherent patterns and meanings. This research finds that LBP subjects articulate a rich world of pain sensation, awareness and meanings. From subjects' own words and experiences we present a patient-centered classification system of backache symptoms based on typical pain intensity, dysfunction, duration and treatment. An elaborate system of explanatory models of LBP and a typology of dominant coping styles designed to either minimize pain or maximize function are also derived. Subjects choose multiple conventional and alternative treatments based on "what works," and articulate ample criticisms of and suggestions for the medical system. In addition, we find that variations in the social construction of the back pain experience vary sharply, even between similar neighboring communities. Given the difficult state of diagnosis and treatment and the frustration of practitioners, attempts at greater understanding of patients' health beliefs, experiences, and behaviors are warranted. Reaching agreement between health provider and patient and addressing patient belief systems may improve outcomes.

Original languageEnglish
Pages (from-to)977-988
Number of pages12
JournalSocial Science and Medicine
Volume40
Issue number7
DOIs
StatePublished - Apr 1995
Externally publishedYes

Bibliographical note

Funding Information:
Support for this project was provided by a Research Grant of the General Health Fund of the Histadrut Labor Union.

Funding

Support for this project was provided by a Research Grant of the General Health Fund of the Histadrut Labor Union.

FundersFunder number
General Health Fund of the Histadrut Labor Union

    Keywords

    • explanatory models
    • low back pain
    • patient-centered

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