The Study

A longitudinal study of experiences of patients with chronic lower back pain (CLBP) using Interpretative Phenomenological Analysis (IPA).

Sherrill Snelgrove

PhD student: School of Psychology, Swansea University

Lecturer

School of Health Science

Swansea University

Aim of the study

•The main aim of this research was to explore the pain experiences of

patients with CLBP.

•To extend understanding of the dynamic nature of the experience of

chronic pain and any changes in psychological responses that accompany

its progress.

Aim of the presentation

To present findings from the first of three sets of interviews that took place

with CLBP patients over a period of three years

Time one: 10 participants ( 3 males, 7 females, aged 39yrs to 76yrs ) prior

to attending a chronic pain clinic.

All participants reported long standing CLBP that was unresponsive to

previous medical and surgical treatments.

All had been referred to the CLBP clinic for assessment by medical or

surgical consultants.

Main Themes representing participants experiences

Crucial nature of the pain

(physicality)

Biomedical understandings Managing the pain

Maintaining integrity

Not being believed

Loss

Relationships with familyand friends

Relationships with health

professionals

Male 62yrs: ‘And all that time those people have seen me I feel like if it was a car with something wrong with it they would have found out how to fix it you know.’

Time 1: findings

• Biomedical model of

understanding

• Maintaining integrity

• Crucial nature of pain:

•Managing the pain.

•Relationship with health

professionals

Maintaining integrity

Eirlys 62yrs: I actually had this fall in work one afternoon and just at the end of the shift and the staff nurse I was working with she did say to me oh gosh do you want to go and see the doctor? I said no it’s the end of my shift Ill go home. And, so I went to the doctor because the following day I could hardly move.’

Paul: ‘I had to retire from my post of Purchasing Officer nineteen years ago. This I found hard to come to terms…Having to leave my job after 20 years service made me feel inadequate because I had never received sick benefit before’.

The Crucial nature of the pain

Eirlys: ‘Id love to wake up in the morning and have no pain but its there all the time you know. So, its not like toothache where you can have your tooth taken out you know. So…’ .

Don: ‘Excruciating is one, and like I said other times I might be walking casually down my daughters and then suddenly something just ahhh and it knocks you, it knocks your breath away.’ The pain is always there but some days it’s really bad you don’t want to get out of bed’

Mona: ‘Why me? I’ve always tried to help people anybody in trouble or anything I’m there like’.

The Crucial nature of the pain: physicality

Sara 39yrs;‘I’m so used to not being without the pain now. I wouldn’t know

what it was like to actually have a day without any. Even when the

painkillers take away that dragging pain away you got, its spreading to

the joints in my knee…, my knees click and clack and my fingers do

that (demonstrates a movement), I’m clumsy, I cant do my daily tasks,

clean around, my house is slowly, you know, I cant do anything and it

drives me crazy, because you know I used to be so house proud 27/4 I

just cant do it, I cant physically do it’.

’.

The Crucial nature of the pain

Eirlys: It makes me feel so tired so heavy I think back pain, ahem ,like toothache, hem, you can have pain in other parts of your body , I think your back makes you feel so heavy and tired because it controls so many other parts of your body doesn’t it you know. She goes onto say ‘I wouldn’t say so much depressions it just makes you ahem, feel old, to begin with, it makes you feel older than you are. Makes you feel old, yes, because, ahem, the way you walk, I know I walk differently than if I could just walk along like you would walk along I feel as if I am hampering my husband because if we do go on holidays, you know, he’ll say, come on we’ll walk down the front here and I think oh I cant you know’.

Managing the pain: medication

Sara 39yrs: ‘Because I get up in the morning and the first thing I do is go straight to the tablets’.

Molly 69yrs: ‘I look at my tablets sometimes and I think I’m ill – that’s how bad it is’.

Dolly: ‘The problem is I’m on so much medication and of course I’m on morphine for the pain which means you get used to it and getting the dose increased. I try not to but of course you know if it doesn’t work you take anything to try and stop the pain. Ahem, but that causes problems itself then that causes other problems so a vicious circle’

Managing the pain: physical coping strategies

Sara reported ‘After a bad night I can’t settle, but the only way I find if

after you’ve taken the pain killers and the pain is still there is to actually

slide off the chair and kneel facing the chair, taking all the weight on my

knees’.

Paula: I tell you what makes it easier is standing underneath the shower

and leaving the shower run on your back .Pain killers, of course and

sometimes a hot water bottle ahem and what else… (husband: the thing you

put in the microwave) Oh yes and I also have a sun lamp.

 

Relationships with Health Professionals

Paul: ‘And all that time those people have seen me I feel like if it was a car

with something wrong with it they would have found out how to fix it you

know.’

Paul goes onto describe his growing loss of faith in the Doctors knowledge

about lower chronic back pain,

‘And yet as I said I’m meeting eminent people like Mr X who said he

doesn’t think it’s a trapped nerve through neurological problems and a lot

of people who I don’t think can deal with backs

Relationships with Health Professionals

Don 60 yrs: ‘They discharged me in the XX and they said there was

nothing wrong with me and yet I go to see a neurologist in XX, gives me

a scan, two scans, one finds a trapped nerve and one was diagnosed as

two tumours. And yet there’s a doctor telling me there’s nothing wrong

with me!’

Paul 62yrs: ‘No, sorry, perhaps I jumped the gun, before I’d had any

operation at all I was under [DrX] in The XX. And he said we cant do

anything more for your pain Mr X because I think its in your head, but I

hadn’t had a scan or nothing then but then my [Dr X] referred me to the

neurologist in The X hospital, well as soon as I had a scan they found the

collapsed discs and. but according to the doctor …it was all in my head!’

Conclusion

The participants do recognise the psychosocial elements of their conditions but

conceptualise their pain in terms of the physicality of the pain that parallels a

biomedical model .

Previous studies have neglected the body and offered incomplete pictures of chronic

pain. In comparison this study brings the ‘body’ back into the picture.

A fragmentation of self suggests patients are battling with pain rather than engaging

or accepting pain.

The potential for acceptance and commitment therapies (ACT) in improving

emotional and physical functioning

Methodological Limitations

• A small sample and generalisations should not be made

•A danger that line by line analysis and detailed analysis ‘misses’ the essence of an individuals concerns, ‘the whole is greater than the sum of it parts’

•IPA papers often present themes as discrete entities rather than related and sequential thereby not offering a coherent interpretation of the experiences

A longitudinal study of experiences of patients with chronic lower back pain (CLBP) using Interpretative Phenomenological Analysis (IPA).

Sherrill Snelgrove

End Of Slides

S.R.Snelgrove@swan.ac.uk

01792 – 513466

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