The first ever episode of non-specific low back pain: advancing knowledge of lay definitions, causal theories and attributions

Abstract

Low back pain is a major health and socio-economic problem in Western countries. It is important therefore to learn more about its cause for prevention. To date, research has focused upon identifying risk factors that play a role in recurrent episodes of low back pain to further knowledge for secondary prevention. It can be argued however that it is more important to prevent the very first episode of low back pain from occurring by learning about the primary causative mechanisms. The aim of this thesis therefore is to advance theories about the possible causes of the first ever episode of low back pain for primary prevention. The qualitative, in-depth interview study presented in this thesis approaches the study of the first ever episode of low back pain, its antecedents and causal attributions from the perspective of subtle realism. Thirty participants presenting to NHS hospital physiotherapy and medical outpatient clinics were recruited for interview. The interview data were transcribed verbatim, and the data managed and analysed using Framework, a method developed by the National Centre for Social Research. The study’s findings advance knowledge about the possible role of psychological distress involving loss, anger, low mood and social withdrawal, and ‘pushing worries to the back of the mind’ in the genesis of non-specific symptoms including low back pain. If confirmed by further research, preventive strategies may need to address the perception that low back pain is not a stress-related condition and gender differences in the conceptualisation of stress. An area for new research is a perceived disposition to physical activity since childhood and a lifestyle described as active before the first ever episode of low back pain. Lay definitions of ‘real’ low back pain may assist the design of this research.