Understanding how patients’ pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach

Ampiah, Josephine Ahenkorah; Moffatt, Fiona; Diver, Claire; Ampiah, Paapa Kwesi

doi:10.1136/bmjopen-2022-061062

Cited by 8 publications

(10 citation statements)

References 68 publications

(195 reference statements)

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“…The socio‐cultural beliefs about chronic musculoskeletal pain, such as low back pain, influence the health‐seeking behaviours of the population (Ampiah et al., 2022). Bhutan is also known as ‘the land of medicinal herbs,’ and remedies made from herbs and minerals plays an important role in Bhutanese society.…”

Section: Discussionmentioning

confidence: 99%

Perspectives on chronic musculoskeletal pain management among healthcare professionals in Bhutan: A qualitative study

Tamang,

Dorji,

Wangdi

et al. 2023

Musculoskeletal Care

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IntroductionMusculoskeletal pain disorders continue to be one of the leading causes of disability worldwide. Best practice care recommends patient‐centred biopsychosocial models of care. Little is known about the chronic musculoskeletal pain management in low‐ and middle‐income countries.ObjectivesTo explore the management of chronic musculoskeletal pain by healthcare professionals in Bhutan.MethodsThis study employed a qualitative design involving 19 Bhutanese healthcare professionals managing chronic musculoskeletal pain in Bhutan. We collected data using a semi‐structured interview guide. Thematic analysis was done manually.ResultsHealthcare professionals reported that patients rely on a combination of home remedies and seek help from local healers and hospitals for chronic musculoskeletal pain management. While healthcare professionals understand chronic musculoskeletal pain as multi‐dimensional phenomenon, the primary focus was on identifying and treating structural anomalies. Time constraints, inadequate knowledge and skills, lack of confidence, facilities and expertise were reported as barriers to the effective management of chronic musculoskeletal pain. They proposed a need for clinical guidelines, relevant skills training and creating awareness of chronic musculoskeletal pain.ConclusionThe management of chronic musculoskeletal pain in Bhutan is focused on identifying and treating physical abnormalities. Healthcare professionals consider psychosocial dimensions important but lack any form of actionable interventions in this domain.

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Section: Discussionmentioning

confidence: 99%

Perspectives on chronic musculoskeletal pain management among healthcare professionals in Bhutan: A qualitative study

Tamang,

Dorji,

Wangdi

et al. 2023

Musculoskeletal Care

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“…Moreover, cultural beliefs and attitudes that are not directly related to religion can act as confounding factors. For example, a study of Ghanaian adults revealed that their religion was a source of hope and support in the face of chronic back pain; on the other hand, many of these adults had culturally-derived maladaptive beliefs related to pain, which were not specifically related to their religion ( 56 ). Similar results regarding the positive role of religion were reported in a study of Spanish and Brazilian patients with back pain ( 57 ).…”

Section: Introductionmentioning

confidence: 99%

The influence of cultural and religious factors on cross-national variations in the prevalence of chronic back and neck pain: an analysis of data from the global burden of disease 2019 study

Rajkumar

2023

Front. Pain Res.

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IntroductionLow back pain and neck pain are among the most commonly reported forms of chronic pain worldwide, and are associated with significant distress, disability and impairment in quality of life. Though these categories of pain can be analyzed and treated from a biomedical perspective, there is evidence that they are both related to psychological variables such as depression and anxiety. The experience of pain can be significantly influenced by cultural values. For example, cultural beliefs and attitudes can influence the meaning attached to the experience of pain, the responses of others to a sufferer's pain, and the likelihood of seeking medical care for particular symptoms. Likewise, religious beliefs and practices can influence the both experience of pain and the responses to it. These factors have also been associated with variations in the severity of depression and anxiety.MethodsIn the current study, data on the estimated national prevalence of both low back pain and neck pain, obtained from the 2019 Global Burden of Disease Study (GBD 2019), is analyzed in relation to cross-national variations in cultural values, as measured using Hofstede's model (n =115 countries) and in religious belief and practice, based on the most recent Pew Research Center survey (n = 105 countries). To address possible confounding factors, these analyses were adjusted for variables known to be associated with chronic low back or neck pain, namely smoking, alcohol use, obesity, anxiety, depression and insufficient physical activity.ResultsIt was found that the cultural dimensions of Power Distance and Collectivism were inversely correlated with the prevalence of chronic low back pain, and Uncertainty Avoidance was inversely correlated with the prevalence of chronic neck pain, even after adjustment for potential confounders. Measures of religious affiliation and practice were negatively correlated with the prevalence of both conditions, but these associations were not significant after adjusting for cultural values and confounders.DiscussionThese results highlight the existence of meaningful cross-cultural variations in the occurrence of common forms of chronic musculoskeletal pain. Psychological and social factors that could account for these variations are reviewed, along with their implications for the holistic management of patients with these disorders.

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“…This fosters holistic understanding of the impact of CLBP and highlights important indicators to be considered in the management of CLBP 12. Conversely, a qualitative study18 and review19 on management practices for LBP in Ghana and African countries suggest the predominance of biomedical and passive strategies (eg, electrotherapy, massage, prolonged pain medication use), and an absence of biopsychosocial strategies. However, exercises are commonly prescribed by Ghanaian physiotherapists 8.…”

Section: Introductionmentioning

confidence: 99%

“…However, exercises are commonly prescribed by Ghanaian physiotherapists 8. Late health seeking and the use of herbal medication for CLBP in Ghana have also been reported by Ghanaian patients experiencing CLBP 18. CLBP is a long-term and complex condition that may persist beyond tissue healing 20.…”

Section: Introductionmentioning

confidence: 99%

“…Both studies reported significant adverse effects on patient’s psychosocial well-being, for example, loss of livelihoods and relationships. The experience and impact of pain is subjective and is affected by cognitive (eg, previous experience of pain), sociocultural (eg, cultural beliefs/roles), economic and structural factors (eg, accessibility to healthcare), which vary in different African, and cultural contexts (eg, rural–urban divide and different tribes) 18 36. In Ghana, the impact of CLBP and biomedically oriented management approaches on patients’ social and psychological well-being are unknown.…”

Section: Introductionmentioning

confidence: 99%

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A Qualitative Investigation of the Psychosocial Impact of Chronic Low Back Pain in Ghana

et al. 2023

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IntroductionChronic low back pain (CLBP) is a global health concern associated with multidimensional/biopsychosocial levels of affectation in developed countries, with holistic management requiring consideration of these factors. There has been minimal research exploring the psychosocial impact of CLBP, and the factors influencing it, in African contexts, with none in Ghana.ObjectivesTo explore the psychosocial impact of CLBP among patients with CLBP in Ghana.DesignQualitative study using individual semistructured face-to-face interviews, underpinned by Straussian grounded theory principles and critical realist philosophy.ParticipantsThirty patients with CLBP attending physiotherapy at two hospitals in Ghana.ResultsFive categories: loss of self and roles, emotional distress, fear, stigmatisation and marginalisation, financial burden, and social support and three mechanisms: acquired biomedical/mechanical beliefs from healthcare professionals (HCPs), sociocultural beliefs and the socioeconomic impact of CLBP were derived.ConclusionCLBP adversely affects multidimensional/biopsychosocial aspects of individuals experiencing CLBP in Ghana. This delineates the need for a biopsychosocial approach to care. There is the need for HCPs in Ghana to reassess current CLBP management strategies to address the influence of adverse HCPs biomedical inclinations on patients’ psychosocial consequences. Population-based education strategies and consideration of formal support systems for persons with disabling CLBP may also be beneficial.

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Understanding how patients’ pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach

Cited by 8 publications

References 68 publications

Perspectives on chronic musculoskeletal pain management among healthcare professionals in Bhutan: A qualitative study

Perspectives on chronic musculoskeletal pain management among healthcare professionals in Bhutan: A qualitative study

The influence of cultural and religious factors on cross-national variations in the prevalence of chronic back and neck pain: an analysis of data from the global burden of disease 2019 study

A Qualitative Investigation of the Psychosocial Impact of Chronic Low Back Pain in Ghana

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