Communicating and diagnosing non-specific low back pain: A qualitative study of the healthcare practitioners perspectives using a social diagnosis framework
Rikke Arnborg Lund, Alice Kongsted, Eva Bäcker Hansen, Corrie Myburgh
Health Sciences Research Centre, University College Lillebælt, 5230 Odense, Denmark
Background: There is general agreement that non-specific low back pain is best understood within a biopsychosocial understanding of health. However, clinicians and patients seemingly adhere to a biomedically derived diagnostic model, which may introduce misperceptions of pain and does not inform treatment or prognosis.
Objective: To explore, from the perspective of health-care practitioners, how persistent non-
specific low back pain may be communicated in a way that moves beyond a biomedical diagnosis.
Design: An explorative qualitative investigation using a constructivist diagnostic framework.
Methods: Focus group and individual interviews of 10 purposefully selected chiropractors, physio-therapists and general practitioners were codified and thematically analysed.
Results: Four themes emerged: “Clinicians’ nuanced understanding of back pain”; “The challenges of shared decision-making”; “Cultural barriers to moving beyond biomedicine”; and “More than a label – individual explanations for pain”. Pain and disability were perceived as products of multiple bio-psycho-social factors. Clinicians identified the impact of multiple social actors, an unhealthy work culture, and the organization of the medical system on the notion of pain and suffering.
Conclusion: Clinicians perceived a need to communicate the complexity of non-specific low back pain in order to help patients make sense of their condition, rather than applying diagnostic labelling. There are multiple barriers to integrating a constructivistic diagnostic framework that need to be overcome.
When presenting with persistent low back pain, more than 9 out of 10 patients cannot be given a structural cause of their symptoms. These individuals receive a diagnosis of non-specific low-back pain, which does little to inform them about the type of problem they have or how it might be remedied. This study used a social diagnosis framework, which considers multiple factors in relation to illness, to explore how physiotherapists, chiropractors and general practitioners might help us to identify a diagnosis (i.e. a label and the meaning we bring to it) alternative to non-specific low back pain. The aim being to enable better communication with patients about their condition. The study found that healthcare practitioners consider multiple biopsychosocial factors relevant to the condition, they consider it important to help patients make sense of their condition, and to engage patients in dealing with individual contributors to pain. Healthcare practitioners did not consider a new diagnostic label for non-specific low back pain to be a priority for their own practice.
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