Getting the pain right: how low back pain patients manage and express their pain experiences.

Purpose: Biopsychosocial interventions in low back pain (LBP) rehabilitation aim at preparing patients to accept and manage their pain conditions and to encourage them to maintain their everyday life routines. Although such approaches have demonstrated a positive effect, for example, in relation to return to work (RTW), few studies have explored how social contexts influence how pain is being managed. Using a theoretical approach that addresses pain as social performance, we illustrate how pain is expressed and managed in three different contexts: at the clinic, at home and at work.

Methods: Qualitative in-depth interviews were conducted with eight patients who had followed a hospital-based RTW intervention.

Results: Low back patients experience dilemmas of how to express their pain sensations and constantly evaluate whether the activities they participate in will ease or worsen their pain sensations. In this process, their behavior is guided by how they think their social role will be affected by their decision to abstain from or undertake the activities in question.

Conclusions: Interventions in rehabilitation may benefit from knowledge of the social processes at play when LBP patients articulate, express and suppress their symptoms in their interaction with health professionals, workmates, families and friends.

Implications For Rehabilitation: Low back pain • In order to manage pain, patients with low back pain are encouraged to exercise and to maintain their everyday activities. • Choosing to become physically active, although in pain, is related to those social roles one wishes to maintain or support. • Future interventions could offer support so that patients will be able both to maintain their social roles and to retire from social activities without their social roles being threatened.