Health maintenance, meaning, and disrupted illness trajectories in people with low back pain: a qualitative study

Abstract

Whilst ‘biographical disruption’ remains important for explaining how people rebuild biography following the onset of chronic illness, it does not self-evidently explain the problem of managing a fluctuating chronic condition such as non-specific low back pain. Chronic illness rarely leads to long-term improvement; the trajectory is not always linear, and sudden or gradual improvements alongside deterioration are commonly experienced. In the case of low back pain, self-management often involves utilisation of non-pharmaceutical approaches, personal resources for accommodating pain and disability, as well as managing symptoms with clinical treatments to relieve pain. Such a multifaceted approach – not only concerned with the reduction of symptoms – shifts focus beyond the ‘disease’ state and a single point of disruption, drawing attention to the use of ‘health maintenance actions’ to facilitate a proactive response to illness management. We propose this new approach as an alternative way of understanding the experience of patients with fluctuating health conditions such as low back pain.

Keywords:

• sociology
• health maintenance
• low back pain
• chronic illness
• qualitative

Additional information

Funding

This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme [Grant Reference Number RP-PG-0707-10131]; a Programme Grant awarded by Arthritis Research UK [Grant Code H0660]; and an NIHR Research Professorship for Nadine Foster [NIHR-RP-011-015].The views expressed are those of the authors and not necessarily those of the NHS.