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Open Access Highly Accessed Research article

A systematic review and meta-synthesis of the impact of low back pain on people’s lives

Robert Froud16*, Sue Patterson23, Sandra Eldridge2, Clive Seale4, Tamar Pincus5, Dévan Rajendran6, Christian Fossum6 and Martin Underwood1

Author Affiliations

1 Warwick Clinical Trials Unit, Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, UK

2 Centre for Primary Care and Public Health, Queen Mary University of London, 58 Turner Street, Whitechapel, London E1 2AB, UK

3 Metro North Mental Health, Royal Brisbane and Womens’ Hospital, Brisbane, Queensland 4029, Australia

4 School of Social Sciences, Brunel University, Uxbridge UB8 3PH, UK

5 Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK

6 University College of Health Sciences, Campus Kristiania, Prinsens gate 7-9, 0153 Oslo, Norway

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BMC Musculoskeletal Disorders 2014, 15:50  doi:10.1186/1471-2474-15-50

Published: 21 February 2014

Abstract

Background

Low back pain (LBP) is a common and costly problem that many interpret within a biopsychosocial model. There is renewed concern that core-sets of outcome measures do not capture what is important. To inform debate about the coverage of back pain outcome measure core-sets, and to suggest areas worthy of exploration within healthcare consultations, we have synthesised the qualitative literature on the impact of low back pain on people’s lives.

Methods

Two reviewers searched CINAHL, Embase, PsycINFO, PEDro, and Medline, identifying qualitative studies of people’s experiences of non-specific LBP. Abstracted data were thematic coded and synthesised using a meta-ethnographic, and a meta-narrative approach.

Results

We included 49 papers describing 42 studies. Patients are concerned with engagement in meaningful activities; but they also want to be believed and have their experiences and identity, as someone ‘doing battle’ with pain, validated. Patients seek diagnosis, treatment, and cure, but also reassurance of the absence of pathology. Some struggle to meet social expectations and obligations. When these are achieved, the credibility of their pain/disability claims can be jeopardised. Others withdraw, fearful of disapproval, or unable or unwilling to accommodate social demands. Patients generally seek to regain their pre-pain levels of health, and physical and emotional stability. After time, this can be perceived to become unrealistic and some adjust their expectations accordingly.

Conclusions

The social component of the biopsychosocial model is important to patients but not well represented in current core-sets of outcome measures. Clinicians should appreciate that the broader impact of low back pain includes social factors; this may be crucial to improving patients’ experiences of health care. Researchers should consider social factors to help develop a portfolio of more relevant outcome measures.

Keywords:
Outcome measurement; Outcome measure development; Low back pain; Qualitative synthesis; Social factors; Population-based interventions