Experiences of chronic low back pain: a meta-ethnography of qualitative research

Abstract

Chronic low back pain (CLBP) is associated with a number of costly disability-related outcomes. It has received increasing attention from qualitative researchers studying its consequences for personal, social, and health care experiences. As research questions and methods diversify, there is a growing need to integrate findings emerging from these studies. A meta-ethnography was carried out to synthesise the findings of 38 separate qualitative articles published on the subjective experience of CLBP between 1994 and 2011. Studies were identified following a literature search and quality appraisal. Four themes were proposed after a process of translating the meaning of text extracts from the findings sections across all the articles. The themes referred to the undermining influence of pain, its disempowering impact on all levels, unsatisfying relationships with health care professionals, and learning to live with the pain. The findings are dominated by wide-ranging distress and loss but also acknowledge self-determination and resilience. Implications of the meta-ethnography for clinicians and future qualitative research are outlined, including the need to study relatively unexamined facets of subjective experience such as illness trajectory and social identity.

Barriers to self-management of chronic pain in primary care: a qualitative focus group study

“…Metaethnographies or meta-synthesis of such studies provide a useful comparator for the current study. The findings resonate with many of the themes discussed: the adversarial struggle to affirm self, explain pain, negotiate the healthcare system, and to be valued and believed; 25 the undermining and disempowering impact of pain, and unsatisfying relationships with healthcare providers; 26 difficulties with activities and stigma; 27 and the impact on self and relations with significant others. 28 The same studies find some evidence of moving forward with pain, accepting and adjusting, and changing outlook.…”

“A life of living death”: the experiences of people living with chronic low back pain in rural Nigeria

“…[16][17][18][19][20] No research has examined the lived experience of people with CLBP in rural Nigeria or anywhere else in rural Africa. Four syntheses of 60 qualitative studies [21][22][23][24] explored CLBP in mostly Caucasians in developed countries. Only three of these studies were conducted outside such countries; in Israel, [25] Iran [26] and South Africa.…”

“…[27] Feelings of distress and loss were a common finding across settings, whereas illness beliefs, treatment expectations and self-management practices differed. [21][22][23][24] Coping through spirituality was notable in South Africa though this may not reflect rural African patients' views as all the included patients were Caucasian females recruited through urban clinics. [27] Therefore, the aim of this study was to explore the experiences of people living with chronic low back pain (CLBP) in a rural Nigerian community.…”

Low back pain: a call for action

“…Preventing the onset and persistence of disability associated with low back pain requires recognition that the disability is inseparable from the social and economic context of people's lives and is entwined with personal and cultural beliefs about back pain. 4 Health and workplace policies and disability payment systems are often ineffective and wasteful and represent key targets for improvements. Socioeconomically disadvantaged people are overrepresented among those with disabling low back pain.5 In many settings they will be further disadvantaged by restricted access to accurate information sources, health care approaches that provide appropriate support for self-management of uncomplicated low back pain, and to more specialised effective interventions, such as multidisciplinary rehabilitation, for more complex persistent low back pain.…”