Illness perceptions in the context of differing work participation outcomes: exploring the influence of significant others in persistent back pain

Abstract

BackgroundPrevious research has demonstrated that the significant others of individuals with persistent back pain may have important influences on work participation outcomes. The aim of this study was to extend previous research by including individuals who have remained in work despite persistent back pain in addition to those who had become incapacitated for work, along with their significant others. The purpose of this research was to explore whether the illness beliefs of significant others differed depending on their relative’s working status, and to make some preliminary identification of how significant others may facilitate or hinder work participation for those with persistent back pain.MethodsInterviews structured around the Illness Perception Questionnaire (chronic pain version) were conducted with back pain patients recruited from a hospital pain management clinic along with their significant others. Some patients had remained in work despite their back pain; others had ceased employment. Data were analysed using template analysis.ResultsThere were clear differences between beliefs about, and reported responses to, back pain symptoms amongst the significant others of individuals who had remained in employment compared with the significant others of those who had ceased work. Three overarching themes emerged: perceived consequences of back pain, specific nature of employment and the impact of back pain on patient identity.ConclusionsSignificant others of employed individuals with back pain focused on the extent to which activity could still be undertaken despite back pain symptoms. Individuals out of work due to persistent back pain apparently self-limited their activity and were supported in their beliefs and behaviours by their significant others. To justify incapacity due to back pain, this group had seemingly become entrenched in a position whereby it was crucial that the individual with back pain was perceived as completely disabled. We suggest that significant others are clearly important, and potentially detrimental, sources of support to individuals with back pain. The inclusion of significant others in vocational rehabilitation programmes could potentially be a valuable way of mobilising readily accessible resources in a way that supports optimal functioning.

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

“…[26] Biomechanical understanding of CLBP has been shown to elevate fear-avoidance beliefs, anxiety, pain intensity, pain catastrophizing, hypervigilance, maladaptive illness perceptions and disability. [84][85][86][87][88][89] Moreover, there is limited evidence linking biomechanical factors to the adverse impact of CLBP. [90] Associating CLBP with ageing led to catastrophic thinking, as reported in previous studies, [25][26][27]58,91] which was more pronounced in the younger participants.…”

Effects of workplace, family and cultural influences on low back pain: What opportunities exist to address social factors in general consultations?

“…While there is evidence of a detrimental consequence of LBP on marital satisfaction, partner emotions and relationship quality [34], there are also beneficial effects of spousal support on LBP coping and function [34,35]. Most of the research on family support and LBP has focussed on' spousal 'communication and emotional support, with a focus on operantconditioning models whereby pain behaviour elicits a communicative interpretation and reaction from partners, and this either reinforces or extinguishes pain behaviours [34,[36][37][38]. If pain behaviour appears to be reinforced by overly sympathetic (solicitous) responses from the patients' partner or family, perhaps this issue could be addressed in the lifestyle advice provided by clinicians.…”

“…The current evidence of the impact of LBP on families is more descriptive than explanatory, but it suggests that family interactions are more complex than those described by the operant-conditioning model [34,38] involving empathy, understanding, communication and congruence between partners/ family members [39]. Two recent qualitative studies on the impact of LBP on the family [40,41] report an associated reduction in shared leisure activities and time spent with family, changes in the parent and child role (e.g., children having to assist in daily duties due to parents' disability), changes in traditional gendered roles (e.g., the wife now works full-time because the husband cannot work), anger and frustration expressed by family members and financial strain (e.g., being out of work due to LBP).…”

The Utility of Template Analysis in Qualitative Psychology Research

“…Findings from this research suggest that there is a danger that patients who feel unable to stay in or return to their previous employment may adopt a very limiting "disabled" identity as a protection from socio-cultural scepticism about their condition, and derogatory rhetoric about "benefits scroungers." Such a strategy for defending the self may lead to a vicious circle whereby the patient focuses on what s/he cannot do, restricts activity further, and exacerbates the condition making it even less likely they will be able to return to work (McCluskey et al 2011;Brooks et al 2013). In the CSM framework, "illness identity" pertains to the specific symptoms associated by a patient with an illness, ideas about the label given to an illness, and beliefs about its nature.…”