PERCEPTIONS OF DIFFERENCE: CONTINUITY AND DISCONTINUITY IN TRAJECTORIES OF CHRONIC LOW BACK PAIN

Abstract

The difficulties in the management of chronic lower back pain are recognised by professionals and patients alike but this recognition can stem from very different perspectives. This paper discusses how patients identify ways in which their experience and perception of pain changes over time and how that impacts on their relationship with professionals delivering a treatment regime. It presents the results of secondary analysis of longitudinal patient data collected under a serial qualitative interview methodology in which the analytical focus is on patients' changing expectations and perceptions of pain. This orientation to the data demonstrates not only established notions of ‘acceptance’ within biographical disruption, but also ways in which individuals revise, mediate, negotiate and integrate meanings of pain to gain both short and long-term coherence. By taking a more holistic view of patient narratives that situates treatment prescriptions and related behaviours within the context of individuals' everyday life, the analysis highlights ‘sense-making’ as a dynamic process. In doing so, it shows that patients draw reference points not only from their most immediate experiences of chronic low back pain but also from the (dis)continuities of lifecourse experience prior to the onset of pain and anticipated for the future. The paper therefore seeks to both illuminate the dynamics of the patient perspective and provide indicators of where some differences in patient/professional perceptions may lie. Suggestions for promoting concordance between patients and health care professionals will be discussed.